Quadratus lumborum and erector spinae plane blocks are effective for analgesia in laparoscopic hysterectomy: a randomized controlled trial

O. Baran

Department of Anesthesiology and Reanimation, Medical Faculty of Tekirdağ Namık Kemal University, Tekirdağ, Turkey. obaran@nku.edu.tr

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• Anesthesiology

OBJECTIVE: Total laparoscopic hysterectomy is the preferred technique for hysterectomy in obstetrics and gynecology clinics. However, patients who undergo these procedures often experience acute pain that may progress to chronic pain over time. Erector spinae plane block (ESPB) and anterior quadratus lumborum block (QLB) under ultrasound guidance are reported to be effective as part of the multi-modal analgesia protocol. Therefore, this study aimed to compare the effectiveness of erector spinae plane block and anterior quadratus lumborum block in reducing postoperative opioid consumption and pain scores in patients undergoing total laparoscopic hysterectomy.

PATIENTS AND METHODS: Eighty-one patients who met the inclusion criteria were divided into three groups: the erector spinae plane block, anterior quadratus lumborum block, and control groups. All patients received general anesthesia and tramadol-based patient-controlled analgesia (PCA) during the postoperative period. Tramadol consumption and pain scores during the first 24 h were evaluated by a blinded researcher. Postoperative opioid consumption was the primary outcome of the study.

RESULTS: Postoperative tramadol consumption was lower in the erector spinae plane block and quadratus lumborum block groups than that in the control group, with no significant differences observed between the two interventional groups. Postoperative pain scores were lower for at least 12 h in both block groups, with no significant differences observed between both groups.

CONCLUSIONS: Erector spinae plane block and quadratus lumborum block improved postoperative pain management as part of the multi-modal analgesia protocol; however, erector spinae plane block may be preferable due to its rapid procedure time. The findings suggest that incorporating erector spinae plane block and quadratus lumborum block into multi-modal analgesia protocols for laparoscopic hysterectomy would have important implications for the development and standardization of pain management protocols.

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