Comparison of Quardatus Lumborum Block Versus Transversus Abdominus Plain Block in Patients Undergoing Total Abdominal Hysterectomy

Abstract

Background: Total abdominal hysterectomy commonly causes moderate to severe postoperative pain. Regional blocks may reduce opioid use. Transversus abdominis plane (TAP) block targets the fascial plane between the internal oblique and transversus abdominis muscles. Quadratus lumborum (QL) block may provide wider somatic and visceral analgesia through thoracolumbar fascial spread. Objective: To compare quadratus lumborum versus transversus abdominis plane blocks for early postoperative pain control and opioid sparing after hysterectomy in women undergoing total abdominal hysterectomy. Methods: A prospective randomized controlled trial conducted at the Department of Anaesthesia, Mayo Hospital, Lahore and enrolled 80 women aged 18 to 60 years undergoing total abdominal hysterectomy under general anaesthesia. Participants were allocated to bilateral QL block (n=40) or bilateral TAP block (n=40). Primary outcome was visual analogue scale (VAS, 0 to 10) pain at 2 hours. Secondary outcomes included VAS at 4 hours, time to first rescue analgesia, 24-hour rescue opioid consumption, patient satisfaction, hospital stay, and adverse events. Results: All participants completed follow up and baseline characteristics were similar. Mean VAS at 2 hours was lower with QL than TAP (2.47 ± 0.79 vs 4.27 ± 0.81, mean difference −1.80, 95% CI, −2.15 to −1.44, p<0.001). QL also reduced 4-hour VAS (2.08 ± 0.96 vs 3.54 ± 0.79, p<0.001), prolonged time to rescue (290 ± 64 vs 212 ± 56 minutes, p<0.001), decreased 24-hour morphine equivalents (5.05 ± 2.69 vs 12.54 ± 4.40 mg, p<0.001), and increased satisfaction (8.48 ± 0.82 vs 7.01 ± 0.81, p<0.001). Adverse events were infrequent and comparable. Conclusion: QL block improved early analgesia and opioid sparing after total abdominal hysterectomy compared with TAP block in women undergoing total abdominal hysterectomy.