The Efficacy of Ultrasound-Guided Bilateral Quadratus Lumborum Block versus Bilateral Transversus Abdominis Plane Block in Patients Undergoing Total Abdominal Hysterectomy

Abstract

Abstract Background Nerve root or myofascial irritation at the abdominal wall is a common cause of pain following surgeries such as cholecystectomy, cesarean section, prostatectomy, hysterectomy and transplant surgery. Spinal or systemic opioid analgesia techniques are often used to manage pain after abdominal surgeries and appropriate pain management is necessary for optimizing clinical outcomes and patients’ satisfaction. However, complications such as nausea, vomiting and respiratory depressions are often associated with opioid use. As a result, investigation of alternative analgesia regimens to enhance effectiveness in postoperative pain management while improving the safety profile has emerged as a significant field of inquire. Aim of the Work To study the analgesic efficacy of ultrasound- guided bilateral trans- muscular quadratus lumborum block (QLB) compared with bilateral transversus abdominis plane (TAP) block on postoperative period regarding pain control, total opioid given in the first 24-hour post-operative, VAS score and first time to ask for analgesia in patients undergoing total abdominal hysterectomy under general anesthesia. Patients and Methods After approval of anaesthesiology department scientific and ethical committees in Ain Shams University Hospitals, 50 female patients were included in the study, and were divided into two groups, each group consisted 25 patients. Group A (TAP): Patients in this group received bilateral US guided TAP block at the end of surgery. Group B (QLB): Patients in this group received bilateral US guided QLB block at the end of surgery. Results As regard the analgesic parameters recorded; in the current study, the VAS was significantly lower in group B QLB block when compared with that of group A TAP block and showed significant difference between both groups at 2,4,8 and 12 hrs postoperatively. Also, time to rescue analgesia, there was clinically and statistically highly significant longer time to 1st rescue analgesic in group B (QLB block) was 8.68±1.14 hours compared to that of group A (TAP block) was 5.24±1.64 hours. Also in the current study, total pethidine consumption ―mg with the mean total consumption in each of Group was 100.80±35.58 mg in the TAP group compared with 78.00±25.33 mg in the QLB group there was highly statistically significant higher mean of total analgesic consumption in group A compared to Group B. Conclusion Bilateral ultrasound-guided QL block provides more potent and longer postoperative analgesia with less analgesia consumption than TAP block after total abdominal hysterectomy.