Erector spinae plane block versus quadratus lumborum block for postoperative analgesia after abdominal hysterectomy: a randomized comparative study

Abstract

Background & objective: Fascial plane blocks have emerged as one of the main parts in multimodal analgesia after major abdominal surgeries. Quadratus lumborum (QL) and erector spinae plane (ESP) blocks could cover both somatic and visceral pain, and have been extensively used by the anesthesiologists. We compared both of the blocks for effectiveness, ease to perform and safety after total abdominal hysterectomy (TAH).

Methodology: We enrolled 64 female participants undergoing TAH, ASA PS I–III, aged 40-60 y, and BMI 18-40 kg/m². The patients were randomized equally into either Group QLB, to receive lateral QL block or Group ESPB to receive ESP block (ESPB), under ultrasound guidance, with bupivacaine bilaterally after surgery. Pain severity during rest and on coughing was measured with visual analogue scale (VAS), time to first analgesic request, total meperidine consumption as rescue analgesic, and frequency of PONV through 24 h were recorded.

Results: ESPB lowered the median VAS throughout the first 18 h with a significant difference (P < 0.001) during rest and cough than QLB. Also, ESPB lowered postoperative meperidine consumption more than the QLB group (62.50 ± 22.00 mg) vs (95.31 ± 26.52 mg) respectively with P < 0.001. ESPB prolonged the duration of analgesia over QLB (853.13 ± 50.51 min) vs (812.34 ± 67.53 min) respectively with a P = 0.008. No differences were recorded regarding PONV and hemodynamic parameters.

Conclusion: Erector spinae plane block is more effective, simple, and safe approach to multimodal analgesia after total abdominal hysterectomy than quadratus lumborum block.

Clinical trial registration No.: NCT05541588 on 15/9/2022.

Abbreviations: EOM - External oblique muscle; ESPB - Erector Spinae Plane Block; HR - Heart rate; IOM - Internal oblique muscle; LA - Local anesthetic; MAP - Mean arterial blood pressure; PACU: Post anesthesia care unit; QLB: Quadratus Lumborum Block; QL - Quadratus Lumborum muscle; TAM: transverses abdominus muscle; TAP - Transversus abdominus plane; VAS - Visual Analogue score.

Keywords: Erector spinae plane block; Hysterectomy; Postoperative pain; Quadratus lumborum block.

Citation: Abdelaziz TSA, Abdou K, Salem M. Erector spinae plane block versus quadratus lumborum block for postoperative analgesia after abdominal hysterectomy: a randomized comparative study. Anaesth. pain intensive care 2024;28(2):333−340; DOI: 10.35975/apic.v28i2.2442

Received: December 27, 2023; Revised: January 16, 2024; Accepted: January 18, 2024