Postoperative analgesic effects of various quadratus lumborum block approaches following major gynecological surgery

Abstract

Background and aims Ultrasound-guided quadratus lumborum block (QLB) is proven to be a beneficial analgesic after abdominal surgery. The aim was to compare the effectiveness of two QLB techniques − types 2 and 3–as well as a QLB (2+3) combination − in reducing postoperative pain after gynecological procedures. Patients and methods Randomized controlled single-blinded trial, 80 patients undergoing gynecological procedures were separated into group C (control group), group Q2 (QLB type 2), group Q3 (QLB type 3), and group Q4 (QLB type 2+3). Following the induction of general anesthesia, the block was carried out in a supine position with lateral tilt. Fentanyl consumption intraoperative, the visual analog scale (VAS) for pain, and the morphine consumption intraoperative and within 48 h of the procedure at scheduled times were used to assess the degree of postoperative pain. Kruskal–Wallis test and one-way analysis of variance were used to assess the data that was not regularly distributed and the normally distributed data, respectively. A P value of less than 0.05 was considered statistically significant. Results VAS at rest was significantly detected between C versus (Q2, Q3, and Q2+3) and Q2+3 versus (Q2 and Q3)] at 0, 4, 6, 12, 24, and 48 h while in VAS at movement significant was detected between C versus (Q2, Q3, and Q2+3) and Q2+3 versus (Q2 and Q3) and Q2 versus Q3 at 4, 6, 12, 24, and 48 h. Fentanyl and total morphine consumption were statistically different among all groups as P value less than 0.001. Morphine at first-time consumption was statistically different among all groups as P value less than 0.001. Conclusion Combined Q2+3 block has superior analgesic impact and could be used to improve pain control with fewer side effects if it was administered more correctly.