Effects of Erector Spinae Plane Block and Transmuscular Quadratus Lumborum Block on Postoperative Opioid Consumption in Total Laparoscopic Hysterectomy: A Randomized Controlled Clinical Trial

Abstract

Introduction: Total laparoscopic hysterectomy (TLH) is a common surgical procedure that is frequently associated with substantial postoperative pain. As part of multimodal analgesia, the erector spinae plane block (ESPB) and transmuscular quadratus lumborum block (TQLB) have been demonstrated to be effective. This study aimed to evaluate whether ESPB and TQLB reduce postoperative pain and opioid consumption after TLH.

Methods: A total of 90 female patients undergoing TLH were randomized to receive either ESPB, TQLB, or no intervention before general anesthesia. All patients received a patient-controlled sufentanil analgesia postoperatively. Postoperative pain and sufentanil consumption were evaluated. The primary outcome was cumulative sufentanil consumption at 12 h postoperatively.

Results: The cumulative sufentanil consumption at 12 h postoperatively was significantly lower in Group ESPB than in Group CON after Bonferroni correction (median [interquartile range], 0 [0, 4] μg vs. 6 [0, 10] μg; median difference = - 3; 95% confidence interval, - 6-0; P = 0.010). There were no significant differences between Group TQLB and CON (0 [0, 4] μg vs. 6 [0, 10] μg; P = 0.098) or between the two block groups (P = 1.000). When compared with Group CON, ESPB and TQLB persistently reduced pain scores until 6 and 4 h after surgery, respectively (P < 0.05). However, no significant differences were found in pain scores between the two block groups.

Conclusions: ESPB and TQLB improved the quality of multimodal analgesia for TLH. ESPB may be more favorable due to the prolonged period of analgesia and decreased opioid consumption after TLH.

Clinical trial registration: Chinese Clinical Trial Registry: ChiCTR2100048165, Registry URL: http://www.chictr.org.cn/showproj.aspx?proj=129578 . Date of registration: July 4, 2021. The patient enrollment began on July 12, 2021.

Keywords: Erector spinae plane block; Multimodal analgesia; Opioid consumption; Postoperative pain; Total laparoscopic hysterectomy; Transmuscular quadratus lumborum block.

Conflict of interest statement

Weiwei Jiang, Min Wang, Xiaoli Wang, Shiyun Jin, Miao Zhang, Lili Zhang, Ye Zhang and Yun Wu declare that they have no conflicts of interest.

© 2023. The Author(s).

Figures

Fig. 1

A schematic diagram of ESPB and TQLB. A The LA injected into the erector spinae plane was expected to extend to the paravertebral space, anesthetizing the thoracolumbar ventral rami and the sympathetic trunk which innervate the uterus and anterolateral abdominal wall. B Ultrasound image of ESPB at T10. C The LA was injected into the erector spinae plane between the tip of the transverse process and the erector spinae muscle. D The LA injected into the plane between the quadratus lumborum and the psoas major was expected to extend to the paravertebral space, anesthetizing the thoracolumbar ventral rami and the sympathetic trunk which innervate the uterus and anterolateral abdominal wall. E Ultrasound image of TQLB. F The LA was injected into the interfascial plane between the quadratus lumborum muscle and the psoas major muscle. ES erector spinae muscle, SG segmental ganglion, TP transverse process, QL quadratus lumborum muscle, PM psoas major muscle, EO external oblique muscle, IO internal oblique muscle, TA transversus abdominis muscle, VB vertebral body

Fig. 2

Consolidated Standards of Reporting Trials flow diagram of participants through each stage of the randomized trial. ASA American Society of Anesthesiologists, BMI body mass index, ESPB erector spinae plane block, TQLB transmuscular quadratus lumborum block, CON control

Fig. 3

NRS scores of visceral pain in the studied groups. Data are expressed as mean (standard deviation). Comparisons between groups were made using linear mixed-model analyses, showing Group ESPB and TQLB exhibited reduced visceral pain scores at rest (A) and in motion at 0.5 h postoperatively (B). Patients in Group ESPB remained significantly lower visceral pain scores at rest until 4 h postoperatively (A) and in motion until 6 h postoperatively (B). *P < 0.05 indicates statistically significant differences compared with Group CON. P values are corrected using Bonferroni correction. ESPB erector spinae plane block, TQLB transmuscular quadratus lumborum block, CON control, NRS numeric rating scale

Fig. 4

Kaplan–Meier survival curve representing the time to first sufentanil administration of PCIA from arrival at PACU (T0). The time to first PCIA was significantly longer in Group ESPB compared with Group CON after Bonferroni correction (P = 0.030). There were no significant differences between the two block groups or between Group TQLB and CON. PCIA, patient-controlled intravenous analgesia, PACU post-anesthesia care unit, ESPB erector spinae plane block, TQLB transmuscular quadratus lumborum block, CON control