A Comparative Study of Transversus Abdominis Plane Block versus Quadratus Lumborum Block for Postoperative Analgesia following Lower Abdominal Surgeries

Abstract

Abstract Background Operations rate increased those days and postoperative pain control. The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using multimodal analgesic therapy, preference for regional techniques, avoidance of sedatives, non-invasive ventilation with supplemental oxygen and early mobilization. Aim of the Work This work aims to compare the efficacy of Transversus Abdominis Plane (TAP) Block versus Quadratus Lumborum 2 (QL 2) 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 lower abdominal surgeries. Patients and Methods After approval of the anesthesiology department and scientific and ethical committees, this Randomized controlled trial study was conducted in Ain Shams University Hospitals. Forty patients scheduled for elective lower abdominal surgeries were included in this study. The patients' age was ranged from 21 to 65 years and with the American Society of Anesthesiologists (ASA) Class-I and II. At the end of the surgery, patients were randomized using a random number table and the use of a closed envelopes technique to receive either quadratus lumborum block (Group QLB), or TAP (transversus abdominis plane) block (Group TAP), each group constitutes of 20 patients. Results In this study, the effect of quadratus lumborum block and transversus abdominis plane block result of decreased incidence and severity of postoperative pain (VAS) resulting in decrease in incidence and degree of sedation and opioid total requirement. The present study showed that the quadratus lumborum block was more efficient than the tansversus abdominis plane block. The first rescue for analgesia (pethidine), total pethidine consumption and pain scores (visual analog scale) indicated that the superiority of the QL block technique affected the TAP block technique. The patients of group TAB had higher pain scores and were the first to ask for rescue analgesia; therefore, they had highest total pethidine consumption in the first 24 hours postoperatively in comparison to patients of group QLB. This is mainly due to the extension of the local anesthetic agent beyond the transverse abdominal plane to the thoracic paravertebral space, which then results in more analgesia, even somatic and visceral pain control. Conclusion Quadratus lumborum block was the most effective technique in providing analgesia after lower abdominal surgeries in comparison to transversus abdominis plane block and even more time covering to rescue opioid.