The effect of quadratus lumborum versus epidural block on perioperative hemodynamic status in elderly patients with cancer colon surgery

Abstract

Background Cancer colon is a significant global cancer cause. TEA is the preferred method for treating pain after major abdominal surgery. However, it has many drawbacks. GDFM using PVI allows individualized fluid administration, particularly in high-risk groups, such as elderly patients. The study aimed to compare the impact of TEA and subcostal anterior QLB on perioperative hemodynamic parameters of elderly patients undergoing colon cancer surgery.Patients and Methods Forty elderly patients were randomly divided into two groups (20 patients received TEA, and 20 patients received bilateral subcostal anterior QLB). Perioperative hemodynamic parameters, upper and lower sensory extension of the blocks, VAS, and the total IV morphine required using PCA 24 hours postoperatively were recorded.Results Comparing bothgroups, group (TEA) demonstrated better perioperative hemodynamic stability regarding MAP (p < 0.05), HR (p < 0.05), fewer intraoperative hypotension episodes (p = 0.011) with fewer doses of ephedrine and noradrenaline (p = 0.016, FEp = 0.605), fewer postoperative hypotension episodes (p = 0.027) and had more T6 and L2 sensory extension of the block (MCp = 0.025,MCp = 0.012). Both groups had similar VAS and required similar IV morphine doses during 24 hours postoperatively.Conclusion The subcostal anterior QLB could be a safe substitute for TEA in open cancer colon surgeries, especially in high-risk patients, due to the steadier perioperative hemodynamic profile obtained.