Ultrasound-Guided Bilateral Transverses Abdominis Plane Block Versus Bilateral Quadratus Lumborum Block on Postoperative Analgesia in Women Undergoing Total Laparoscopic Hysterectomy

Background: No trials were comparing the Bilateral Quadratus lumborum (QL) block versus transverses abdominis plane (TAP) block in patients undergoing laparoscopic hysterectomy. Hence the present study compared the ultrasound-guided bilateral TAP and QL blocks in patients undergoing total laparoscopic hysterectomy and measured the pain score, rescue anesthesia requirement, adverse events, and patient satisfaction. Materials and Methods: This prospective randomized controlled open-labeled study was conducted on 140 adult female patients (ASA I-II) who were scheduled for total laparoscopic hysterectomy. Patients were randomized into two equal groups of 70 each (group TAP and group QL). Each patient received either Ultrasound-guided bilateral TAP or QL block after completion of laparoscopic hysterectomy under general anesthesia. Patients were monitored for Visual Analogue Scale (VAS) scores postoperatively, time for first analgesic requirement, and adverse effects if any. Independent t-test and Chi-square test were used for statistical analysis. Results: Group QL showed significantly better VAS scores up to 24 hr postoperatively. VAS scores were significantly higher in group TAP than in group QL at all intervals postoperatively (p<0.05), the duration of postoperative analgesia was significantly shorter in group TAP than in group QL (p<0.05), and the total analgesic requirement was lesser in group QL than group TAP (p<0.05). Time for the first request for rescue analgesia was significantly longer in the group QL than in group TAP (497.774±35.45 vs 247.55±11.71min, p<0.001), and its consumption was significantly lesser in the group QL than in group TAP (72.1428±18.328 vs 138.57±25.77mg). The time for the first analgesic demand (Tramadol) was prolonged in group QL than in group TAP (15.1± 2.12 vs 4.35 ±5 hours). The sensory level was higher in the group QL than in the group TAP with a significant difference (7.92±0.51 vs 5.97±0.35, p<0.001). Three patients (4.28%) in the group QL experienced vomiting versus 6 (8.57%) in group TAP. Patient satisfaction score was comparable between group TAP and group QL (4.78 ± 0.45 vs 4.22 ± 0.42). Conclusion: Bilateral QL block provided a better postoperative analgesia technique than bilateral TAP block in women undergoing laparoscopic hysterectomy