Enhanced Recovery and Postoperative Analgesia After Laparoscopic Myomectomy: A Randomized Controlled Trial Comparing Total Intravenous Anesthesia, Transversus Abdominis Plane Block with Rectus Sheath Block, and Quadratus Lumborum Block.

OBJECTIVE

This study compares the effects of total intravenous anesthesia (TIVA, Group A), general anesthesia combined with transversus abdominis plane block and rectus sheath block (TAPB+RSB, Group B), and general anesthesia combined with quadratus lumborum block at the lateral supra-arcuate ligament (QLB-LSAL, Group C) on postoperative pain and recovery in patients undergoing laparoscopic myomectomy.

METHODS

This was a prospective, single-center, randomized controlled trial involving 120 patients (1:1:1 randomization). The primary outcome was the visual analog scale (VAS) score for oxytocin-induced uterine contraction pain at 24 hours postoperatively (T16). Secondary outcomes included postoperative analgesic efficacy, intraoperative anesthetic consumption, hemodynamics, recovery indicators, and adverse reactions.

RESULTS

Group C exhibited significantly lower oxytocin-induced contraction VAS scores than Groups B and A, with Group B also lower than A (all P<0.05). Postoperatively, Group C had the lowest resting/exercise VAS scores, analgesic pump presses, and rescue analgesia needs within 48 hours (P<0.05). Intraoperatively, Group C required the least propofol, remifentanil, and sufentanil, demonstrated superior hemodynamic stability, faster recovery/extubation, shorter PACU stays, better muscle strength, and higher QoR-15 scores (all P<0.05). PONV incidence was lower in Group C than A (P<0.05). No significant differences were found in patient demographics, operative/hospitalization time, or sleep quality, and no major block-related complications occurred.

CONCLUSION

General anesthesia combined with QLB-LSAL can effectively alleviate postoperative uterine contraction pain, reduce the need for anesthetic drugs during and after surgery, promote early recovery, and does not increase the risk of complications, making it an optimized anesthesia protocol for laparoscopic myomectomy.