Erector Spinae Plane Versus Quadratus Lumborum Blocks for Pain Management After Total Abdominal Hysterectomy

Comparative Efficacy of Erector Spinae Plane and Quadratus Lumborum Blocks in Managing Postoperative Pain for Total Abdominal Hysterectomy: A Randomized Controlled Trial

TAH, being a large scale gynaecological operation, is a construction bound to cause serious postoperative pain to the patient in that the procedure will inevitably entail massive tissue dissection. Management of this postoperative pain is of utmost significance because poor analgesia may lead to delayed mobilization of the patient, long duration of hospitalization and also general increase in the morbidity of postoperative period. Traditionally, in these facilities, opioid analgesics are the most common and the most popular means of controlling postoperative pain. Nevertheless, the varied and pervasive use of opioids is largely constrained by its well-reported, dose-dependent systemic adverse effects. Nausea, vomiting, sedation, and respiratory depression are complications that severely degrade the recovery process of the patient and reduce his or her satisfaction.

Study Overview

• Status: Not yet recruiting
• Conditions: Post Operative Analgesia
• Intervention / Treatment: Procedure: Erector Spinae Plane Block; Procedure: Quadratus Lumborum Block (QLB)

Detailed Description

Patients who met the inclusion criteria were recruited in the trial after getting approval from the Hospital Ethical Review Committee and REU CPSP. Demographic information such as age, height, weight, body mass index as well as the functional classification (ASA) was documented on a pre-made proforma. Patients were randomized into two groups using a computer-generated randomisation process.

Group A: Received an ultrasound-guided erector spinae plane block at the T9-T10 level using 20 ml of 0.25% bupivacaine.

Group B: Received an ultrasound-guided posterior quadratus lumborum block using 20 ml of 0.25% bupivacaine.

A qualified anaesthesiologist performed each block in aseptic settings prior to surgery. Standardised general anaesthesia was administered to each patient. The Visual Analogue Scale (VAS) was used to quantify pain at rest and on coughing at 2, 6, 12, 18, and 24 hours. Patents with VAS score more than 4, were given rescue analgesia and the cumulative amount of analgesics used in the first 24 hours as well as the time of the first rescue analgesia were recorded. Patient satisfaction with pain treatment as well as adverse effects such nausea, vomiting, and hypotension were tracked for a duration of 24 hours after the surgery

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Hamid Altaf Altaf; Phone Number: +92 341 4764956; Email: hamidaltaf331@gmail.com

Study Locations

• Pakistan
  • Azad Kashmir
    • Muzaffarabad, Azad Kashmir, Pakistan, 13100
      • SKBZN CMH Muzaffarabad
      • Contact: Bukhari; Phone Number: 03408133982; Email: medisolepro@gmail.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

Patients aged 35-60 years. ASA physical status I or II. Elective Total Abdominal Hysterectomy under General Anesthesia.

Exclusion Criteria:

Allergy with local anesthetics. Infection in the injection site. Coagulopathy or anticoagulant use. Morbid obesity (BMI > 35 kg/m²).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Group B	Procedure: Quadratus Lumborum Block (QLB); Ultrasound-guided posterior quadratus lumborum block using 20 ml of 0.25% bupivacaine.
Active Comparator: Group A	Procedure: Erector Spinae Plane Block; Ultrasound-guided erector spinae plane block at the T9-T10 level using 20 ml of 0.25% bupivacaine.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post Operative Pain	Visual Analogue Score a one-dimensional indicator of pain severity. It is made up of a horizontal line that is 10 cm (100 mm) long and has two end points marked "No Pain" (0) and "Worst Possible Pain" (10). On the line, the patient marks the point that most accurately depicts their level of discomfort at 2,4,6,18 & 24 hours post operatively.	24 Hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to first Rescue Analgesia	When a patient's pain score surpasses a certain threshold (e.g., VAS > 4), additional analgesic medication is administered when the primary anaesthetic approach is unable to give sufficient pain relief and the time will be calculated in hours.	24 Hourse
Cumulative Opioid consumption	The total amount of opioid medicine needed by the patient over the course of the first 24 hours following surgery in order to sustain sufficient analgesia. This is frequently computed as the Morphine Equivalent Dose (mg) and standardised.	24 Hours
Adverse effects	Unwanted and unpleasant effects like nausea, vomiting during 24 hours post operatively	24 Hours
Patient Satisfaction	A conventional 5-point Likert scale that ranges from "Very Dissatisfied" to "Very Satisfied" is usually used to gauge the patient's subjective assessment of the level of pain care they got during 24 hours duration post-operatively	24 Hours

Collaborators and Investigators

• Sponsor: Sheikh Khalifa Bin Zayed Al Nahyan Combined Military Hospital Muzaffarabad

Publications and helpful links

General Publications

• Korgvee A, Junttila E, Koskinen H. Ultrasound-guided quadratus lumborum block for postoperative analgesia: A systematic review of case reports and randomized controlled trials. J Clin Anesth. 2021;71:110214
• Adhikary SD, Pruett A, Forero M, Thiruvenkatarajan V. Erector spinae plane block versusquadratus lumborum block: a meta-analysis of randomized controlled trials. Reg Anesth Pain Med. 2021;46(10):854-863.
• Chavan R, Goklani A, Chavan G, Mali V. Comparison of anterior quadratus lumborum block versus lumbar erector spinae plane block for postoperative analgesia in total abdominal hysterectomy: A randomized controlled study. Pain Med. 2025;26(1):12-18
• Baran O, Şahin A, Arar C. Comparative efficacy of erector spinae plane and quadratus lumborum blocks in managing postoperative pain for total abdominal hysterectomy: A randomized controlled trial. Medicine (Baltimore). 2024;103(43):e40313.
• Abdelaziz TSA, Abdou K, Salem M. Erector spinae plane block versus quadratus lumborum block for postoperative analgesia after abdominal hysterectomy: a randomized comparative study. Anaesth Pain Intensive Care. 2024;28(2):333-340.
• Zewdu D, Tantu T, Eanga S. Analgesic efficacy of erector spinae plane block versus transversus abdominis plane block for laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne). 2024;11:1399253.

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): September 30, 2026
• Study Completion (Estimated): November 30, 2026

Study Registration Dates

• First Submitted: March 13, 2026
• First Submitted That Met QC Criteria: March 13, 2026
• First Posted (Actual): March 18, 2026

Study Record Updates

• Last Update Posted (Actual): March 18, 2026
• Last Update Submitted That Met QC Criteria: March 13, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: erector spinae plane block; Quadratus Lumborum Blocks; Abdominal Hysterectomy; post operative analgesia,
• Other Study ID Numbers: ANS-2023-106-3308

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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