Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Post-Operative Pain Management after Open Appendectomy

Abstract

Abstract Background The transversus abdominis plane (TAP) block has been used for post-operative pain relief in various abdominal surgeries as part of the multimodal analgesic approach. It creates satisfactory somatic analgesia with insignificant or no visceral blockade. Aim of the Work The aim of this study was to assess the analgesic efficacy of ultrasound-guided trans-muscular QLB compared with TAP block during appendectomy surgery and in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions. Patients and Methods After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, patients were included in the study, and were divided into two groups (n = 25; each); group QLB and group TAP. Group QLB: Patients (n = 25) of this group received right side ultrasound-guided QLB after induction of general anesthesia using 0.2 ml/kg bupivacaine 0.25%. Group TAP: Patients (n = 25) of this group received right side ultrasoundguided TAP block after induction of general anesthesia using 0.2 ml/kg bupivacaine 0.25%. Results The study's results show the differences in the analgesic efficacy between US guided QL block & TAP block which are as follow: The patient group that had TAP block as analgesia for appendectomy require higher level of analgesia post op, this can be explained by the fact that the average MBP of this group is predominently higher than in QL group, as well as SBP & DBP differences are evident & higher in TAP block group. The patients HR as a response to pain is significantly high in TAP block group. This was clearly reflected on the time for the first time analgesia needed postoperative, the TAB block group needs analgesia faster & needs more doses of Pethidine. The VAS score is also higher in QL group. Conclusion Quadratus lumborum block was more effective technique in providing analgesia after appendectomy in comparison to transversus abdominis plane block and even more time covering to rescue opioid.