Effectiveness of Combined Fascial Plane Blocks for Postoperative Pain in Gynecologic Oncology Surgery

Postoperative Analgesic Efficacy of Combined Fascial Plane Blocks After Gynecologic Oncologic Surgery

The goal of this prospective observational study is to compare the effectiveness of different postoperative analgesic techniques in patients undergoing major abdominal surgery for gynecologic oncology.

The main question is whether the combination of TAP block with Quadratus Lumborum Block (QLB) or Rectus Sheath Block (RSB) provides superior pain relief compared to TAP block alone.

All blocks were performed as part of routine clinical anesthesia practice according to the attending anesthesiologist's judgment. No randomization, allocation, or study-directed intervention was performed.

Patients were classified into three groups based on the block type they received during standard care:

Group 1: TAP Block Only

Group 2: TAP + QLB Combination

Group 3: TAP + RSB Combination

Postoperative data, including pain scores (VAS), opioid consumption, sedation level, heart rate, blood pressure, nausea/vomiting, and length of hospital stay, were collected prospectively.

The study aims to determine which block combination provides the best postoperative pain control and recovery profile in patients undergoing gynecologic oncology surgery.

Study Overview

• Status: Completed
• Conditions: Postoperative Pain Management; Gynecologic Cancers
• Intervention / Treatment: Other: Group 1:The Transversus Abdominis Plane (TAP) block; Other: Group 2: TAP Block + Quadratus Lumborum Block (QLB); Other: Group 3: TAP Block + Rectus Sheath Block (RSB)

Detailed Description

This study is a prospective observational research designed to evaluate the postoperative analgesic effectiveness of different combinations of fascial plane blocks in patients undergoing gynecologic oncology surgery.

All blocks (Transversus Abdominis Plane [TAP] block, Quadratus Lumborum Block [QLB], and Rectus Sheath Block [RSB]) were performed as part of routine clinical anesthesia practice according to the attending anesthesiologist's preference.

No intervention, randomization, or protocol-directed procedure was applied for research purposes. After data collection, patients were classified into three groups based on the block type they had received in standard care:

TAP block only

TAP + QLB combination

TAP + RSB combination

The study prospectively compared postoperative pain scores (VAS), opioid consumption, time to mobilization, bowel function recovery, and length of hospital stay among these groups to determine the most effective analgesic strategy within routine practice.

This observational design reflects real-world anesthesia management and does not involve any experimental or interventional component.

• Study Type: Observational
• Enrollment (Actual): 94

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Ankara, Turkey (Türkiye)
    • Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

The study population consists of adult female patients who are undergoing elective major abdominal surgery due to gynecologic cancer (e.g., endometrial cancer, ovarian cancer, debulking surgery). Participants will be aged 18 years and older, and only those with ASA I-IV status who are deemed fit for surgery will be included.

Description

Inclusion Criteria

• Age 18 years or older.
• ASA physical status I-IV.
• Scheduled for major gynecologic oncology surgery (endometrial cancer, ovarian tumor, or cytoreductive surgery).
• Undergoing general anesthesia.
• Planned postoperative abdominal fascial plane block for pain management (TAP, TAP + QLB, or TAP + RSB).
• Able to provide written informed consent.

Exclusion Criteria

• Refusal to participate or inability to provide informed consent.
• Emergency surgery.
• Known allergy or contraindication to local anesthetics.
• Infection at the block site.
• Coagulopathy or anticoagulant use that contraindicates regional anesthesia.
• Pre-existing chronic pain conditions or chronic opioid use.
• Severe hepatic or renal insufficiency.
• Cognitive impairment that prevents reliable pain assessment.

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Group 1: TAP Block Only Group; Patients who received only Transversus Abdominis Plane (TAP) block as part of routine anesthesia practice. No additional regional block was performed.	Other: Group 1:The Transversus Abdominis Plane (TAP) block; Patients who received only Transversus Abdominis Plane (TAP) block as part of routine clinical anesthesia practice. No study-assigned intervention or randomization was performed. Data were collected prospectively from standard anesthesia records.
Group 2: TAP + QLB Combination; Patients who received both TAP block and Quadratus Lumborum Block (QLB) as part of standard clinical anesthesia management.	Other: Group 2: TAP Block + Quadratus Lumborum Block (QLB); Patients who received TAP block combined with Quadratus Lumborum Block (QLB) during routine anesthesia management. This block combination was chosen by the attending anesthesiologist as part of standard care, not assigned by the study.
Group 3: TAP + RSB Combination; Patients who received both TAP block and Rectus Sheath Block (RSB) as part of standard clinical anesthesia management.	Other: Group 3: TAP Block + Rectus Sheath Block (RSB); Patients who received TAP block combined with Rectus Sheath Block (RSB) as part of routine anesthesia practice. The block technique was performed according to clinical judgment, not as part of a study intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total Morphine Consumption	Total amount of morphine (mg) administered to the patient within the first 24 hours after surgery for postoperative analgesia. Morphine use will be recorded from patient-controlled analgesia (PCA) device data or medical records.	Within 24 hours after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative pain intensity (VAS score)	Pain intensity will be evaluated using the Visual Analog Scale (VAS; 0 = no pain, 10 = worst pain) at 0 min, 15 min, 2 hr, 6 hr, 12 hr, and 24 hr postoperatively.	0-24 hours postoperatively; VAS score (0-10)
Incidence of postoperative nausea and vomiting	Number of patients experiencing postoperative nausea and/or vomiting within the first 24 hours.	Time Frame: 0-24 hours postoperatively
Time to first gas or stool passage	Time from the end of surgery to the first postoperative bowel movement or passage of gas.	From the end of surgery up to postoperative 72 hours
Time to mobilization	Time from the end of surgery to the first postoperative ambulation.	From the end of surgery up to postoperative 72 hours
Time to oral intake	Time from the end of surgery to the first postoperative oral feeding	From the end of surgery up to postoperative 72 hours
Length of hospital stay	Total duration of hospitalization after surgery.	From surgery to hospital discharge (up to 10 days) Unit of Measure:Days
Intensive care unit (ICU) length of stay	Total duration of postoperative stay in the intensive care unit.	From surgery to hospital discharge (up to 3 days) Unit of Measure: Days

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
1.Sedation Level (Ramsey Sedation Score)	Sedation level evaluated using the Ramsey Sedation Scale at multiple postoperative time points.	0-24 hours after surgery

Collaborators and Investigators

• Sponsor: Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital

Publications and helpful links

General Publications

• Yu S, Wen Y, Lin J, Yang J, He Y, Zuo Y. Combined rectus sheath block with transverse abdominis plane block by one puncture for analgesia after laparoscopic upper abdominal surgery: a randomized controlled prospective study. BMC Anesthesiol. 2024 Feb 9;24(1):58. doi: 10.1186/s12871-024-02444-6.
• Zhu JL, Wang XT, Gong J, Sun HB, Zhao XQ, Gao W. The combination of transversus abdominis plane block and rectus sheath block reduced postoperative pain after splenectomy: a randomized trial. BMC Anesthesiol. 2020 Jan 23;20(1):22. doi: 10.1186/s12871-020-0941-1.
• Akerman M, Pejcic N, Velickovic I. A Review of the Quadratus Lumborum Block and ERAS. Front Med (Lausanne). 2018 Feb 26;5:44. doi: 10.3389/fmed.2018.00044. eCollection 2018.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2024
• Primary Completion (Actual): January 1, 2025
• Study Completion (Actual): March 20, 2025

Study Registration Dates

• First Submitted: April 7, 2025
• First Submitted That Met QC Criteria: December 17, 2025
• First Posted (Actual): December 31, 2025

Study Record Updates

• Last Update Posted (Actual): December 31, 2025
• Last Update Submitted That Met QC Criteria: December 17, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: Postoperative Analgesia; Fascial Plane Blocks for postoperative Analgesia (TAP Block, QLB, RSB); Gynecologic Oncology Surgery
• Additional Relevant MeSH Terms: Digestive System and Oral Physiological Phenomena; Dentistry; Dental Physiological Phenomena; Dental Occlusion
• Other Study ID Numbers: FASIALBLOCKJinekoOnkoAnj

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No