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

Efficacy of Ultrasound Guided Single Level Paravertebral Block vs Transmuscular Quadratus Lumborum Block (III) for Postoperative Analgesia after Percutaneous Nephrolithotomy Surgeries- A Randomised Clinical Study

Introduction: Pain control forms an essential component of enhanced recovery after surgery. Regional nerve blocks forms the mainstay of pain relief now-a-days. Pain after Percutaneous Nephrolithotomy (PCNL) surgeries is always distressing to the patient due to injury to the renal capsule. Aim: To compare the efficacy of Ultrasound (USG) guided Paravertebral Block (PVB) versus Quadratus Lumborum Block (QLB) for postoperative analgesia following PCNL surgeries. Materials and Methods: This randomised clinical study was done between February 2021 to August 2022 at Narayana Medical College and Hospitals, Nellore, Andhra Pradesh, India. Sixty patients of American Society of Anaesthesiology (ASA) I and II between 30-60 years age group undergoing PCNL surgeries were divided into two groups. Group P received USG guided PVB at T9-T10 level with 20 mL of 0.25% Levobupivacaine with 8 mg Dexamethasone whereas group Q received QLB (III) with 20 mL of 0.25% Levobupivacaine with 8 mg Dexamethasone. Visual Analogue Score (VAS), time for first rescue analgesic and number of patients requiring rescue analgesic in first 24 hours were measured. unpaired t-test was used to compare continuous variables whereas the Chi-square test was to compare the categorical variables. Results: There was no statistical difference in terms of sex, age, weight, height or ASA grade (p>0.05). The mean time required for rescue analgesia in group P was around 478 minutes compared to group Q with 346 minutes which was statistically significant (p=0.001). Mean tramadol consumption in group Q was significantly high (155 mg) compared to group P (125 mg). VAS was significantly better in group P. Conclusion: USG guided single level PVB provides superior analgesia compared to transmuscular QLB for postoperative analgesia after PCNL surgeries which helps in enhanced recovery after surgery