Erector Spinae Plane, Quadratus Lumborum, and Transversus Abdominis Plane Blocks for Postoperative Pain After Gynecological Laparotomy: A Randomized Controlled Trial.

PURPOSE: The objective of this study was to evaluate and compare the effects of transversus abdominis plane block (TAPB), quadratus lumborum block (QLB), and erector spinae plane block (ESPB) with no regional block on postoperative opioid consumption, pain intensity, patient satisfaction, and adverse effects in patients undergoing gynecological abdominal laparotomy.

DESIGN

A prospective, randomized controlled study.

METHODS

A total of 80 female patients, ranging in age from 18 to 69 years, with ASA physical status I or II, were scheduled to undergo major gynecological abdominal surgery via laparotomy, were enrolled. Patients were randomly assigned to one of 4 groups (n=20 per group). Patients were randomly assigned to one of four groups and received 0.125% bupivacaine via ultrasound-guided ESPB (Group E), TAPB (Group T), QLB (Group Q), or no regional block (Group C received patient-controlled analgesia (PCA) only), prior to extubation. Demographic and intraoperative data, hemodynamic variables, morphine consumption, pain scores at rest and on movement, patient satisfaction scores, and side effects were recorded at 1, 2, 6, 12, and 24 hours postoperatively.

FINDINGS: The demographic and hemodynamic data of the groups were similar. Post hoc comparisons revealed that VASrest and VASmovement scores were significantly lower in group E compared to groups T and C at 1 and 2 hours postoperatively. Group C had a higher total morphine consumption via PCA than Group E at 1, 2, 6, 12, and 24 hours after surgery. No significant differences in total morphine consumption were observed among groups E, Q, and T. There was no significant difference in patient satisfaction scores among the groups at any time point. The number of patients requiring rescue analgesia was significantly higher in group C compared to the other groups at the first postoperative hour. The incidence of side effects was similar between the groups.

CONCLUSION

TAPB, ESPB, and QLB all reduced morphine use and had lower VAS scores in the early postoperative period, without side effects. Although total morphine consumption was comparable among the ESPB, QLB, and TAPB groups, the ESPB had significantly lower VAS scores at rest and on movement during the early postoperative period.