A Comparative Study of Ultrasound-Guided Quadratus Lumborum Block and Transversus Abdominis Plane Block for Postoperative Analgesia Following Total Abdominal Hysterectomy.

Abstract

Total abdominal hysterectomy (TAH) results in remarkable postoperative pain.Truncal nerve blocks like the quadratus lumborum (QL)blockand transversus abdominis plane (TAP) block are described to combat this pain. The aim of the present study was to compare the effectiveness of the QL block with the TAPblock in terms of numeric rating scale (NRS) scores as the primary outcome for postoperative pain in TAH. The secondary outcome was time of the first analgesic demand, totalanalgesic demandsrequiredin 24 hr, and patient satisfaction level. Seventy patientsofAmerican Society of Anesthesiologists(ASA) physical status classI andII, aged35-65 years with a body mass index (BMI) 18-30 kg/m2planned forelective TAH under spinal anaesthesiawere randomly allocated into two groups.Group Q received QL blockandGroup T received TAP block under ultrasound guidance with 40 ml of 0.25% bupivacaine ofwhich 20 ml was injected on either side. Demographic data of both groups was comparable. The NRS pain score was significantly lower in Group Qcompared to Group Tat the fourthand sixthhour. The mean first analgesic demand was significantlyearlyin Group Tcompared toGroup Q (5.69 ± 0.87 hr vs. 11.23 ± 2.22 hr) and total analgesic demands were significantly greater in Group T thanGroup Q. The mean patient satisfaction score was significantly highin Group Qcompared to Group T (5.8 ± 0.41vs. 4.74 ± 0.44). The combined posterior and anterior approach of the QL block may represent a more efficacious alternativeto the TAP block in patients afterTAH.Further studies are recommended to evaluate the ideal dose, volume and approach for the QL block.