Comparison of the effects of bilateral transversus abdominis plane block and bilateral quadratus lumborum block on postoperative analgesia in patients undergoing midline laparotomy

"Comparison of the Effects of Bilateral Transversus Abdominis Plane Block and Bilateral Quadratus Lumborum Block on Postoperative Analgesia in Patients Undergoing Midline Laparotomy" Aim: The primary aim of this study is compare the effect of bilateral oblique subcostal TAPB and bilateral QLB2 and QLB3 on total opioid requirement in the first 24 hours postoperatively in laparotomy performed with midline incision. The secondary aim of the study is early postoperative pain scores (VAS), first rescue analgesic need times, nausea and vomiting scores and pruritus scores were compared. Materials and Methods: Patients with ASA1-3 between the ages of 18-70 who underwent laparotomy with midline incision in the operating rooms of Ankara University Medical Faculty Hospital were included. Bilateral QLB2-QLB3 or bilateral oblique subcostal TAPB with 0.3 ml/kg of 0.25% bupivacaine was applied to patients who underwent laparotomy under general anesthesia before the patient was awakened at the end of the surgery. After awakening the patients, a 1mg bolus 10-minute lock-time IV PCA device containing morphine was prepared and administered. Postoperative 15th min, 2, 4, 8,12,16,24. Patients' VAS scores, nausea/vomiting scores, pruritus scores, when first rescue analgesic needed, lower extremity motor power, total amount of opioid used during the first 24 hours postoperatively, total additional analgesic need were recorded. Results: There were 62 patients in the QLB group and 60 patients in the TAPB group. 2 patients in the QLB group were not included in the statistical analysis due to lack of data. There was no significant difference between patients' demographic data (except ASA score), surgery types, amount of local anesthetic drug used, presence of postoperative nausea-vomiting, itching, need for antiemetic medication, ICU stay, postoperative complications, and the times when the first postoperative additional analgesic was needed. Considering the ASA scores, there was a significant difference between the two groups (p<0.001). The total amount of morphine used in the QLB group in the first 24 hours was found to be significantly lower (p<0.001). Resting and movement VAS values were significantly lower in the QLB group at all hours (p<0.05). Additional analgesic use was higher in the TAPB group at all times than in the QLB group. When the use of additional analgesics was examined in terms of time trend between the groups, a significant difference was found (p<0.001). Conclusion: QLB is also effective for visceral pain in the control of postoperative acute pain in patients undergoing midline laparotomy; It provides more effective pain control than TAPB, significantly reduces postoperative opioid use compared to TAPB, and increases patient satisfaction. Key words: Quadratus lumborum block, Transversus abdominis plane block, Postoperative pain