Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Patients Undergoing Total Abdominal Hysterectomy: A Randomized Prospective Controlled Trial

Naglaa Khalil Yousef, Naglaa Khalil Yousef

Abstract

Background: Abdominal hysterectomy is associated with sever postoperative pain. Quadratus lumborum (QL) block is a regional analgesic technique which has an evolving role in postoperative analgesia.

Aims: we aimed to compare ultrasound guided bilateral transverse abdominis plane (TAP) block versus bilateral QL block in patients undergoing total abdominal hysterectomy.

Settings and design: This is a prospective randomized controlled double blinded study.

Patients and methods: Sixty adult female patients (ASA I-II), scheduled for total abdominal hysterectomy were randomized into two equal groups (TAP group and QL group). Each patient received general anesthesia plus bilateral TAP block or bilateral QL block. We recorded postoperative total dose of morphine used / 24 hours, Visual Analuge Scales (VAS) for pain (at 30 min, 2, 4, 6, 12, and 24 hours postoperative), duration of postoperative analgesia, total dose of fentanyl use intraoperative, number of patients needed rescue analgesia and any side effects.

Statistical analysis: Independent sample T test and Chi-Square (X2) test were used as appropriate.

Results: Patients in QL group consumed significantly less fentanyl and morphine than patients in TAP group, VAS for pain was significant higher in TAP group than in QL group at all times, the duration of postoperative analgesia was shorter in TAP group than in QL group, the number of patients requested analgesia was significantly higher in TAP group than in QL group.

Conclusions: Bilateral QL block provided better intraoperative and postoperative analgesia with less opioids consumption compared with bilateral TAP block, in patients undergoing total abdominal hysterectomy.

Keywords: Hysterectomy; quadratus lumborum block; transversus abdominis plane block.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Transversus abdominis plane block. EO = External oblique muscle, IO = Internal oblique muscle, TA = Transversus abdominis muscle, LA = Local anesthetic drugs (original figure)
Figure 2
Figure 2
Quadratus lumborum block. QL = Quadratus lumborum muscle, EO = External oblique muscle, IO = Internal oblique muscle, TA = Transversus abdominis muscle, LA = Local anesthetic drugs, TLF = Thoracolumbar fascia (original figure)
Figure 3
Figure 3
CONSORT flow diagram

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