Comparison of erector spinae plane block, quadratus lumborum block and transversus abdominis plane block in postoperative pain treatment in gynecological abdominal surgeries

Comparison of erector spinae plane block, quadratus lumborum block and transversus abdominis plane block in postoperative pain treatment in gynecological abdominal surgeries Objective: Our study aimed to compare the effects of erector spinae plane block (ESPB), quadratus lumborum block (QLB), and transversus abdominis plane (TAP) block on patient-controlled morphine consumption, postoperative pain score, emergency analgesic use, patient satisfaction scores, and side effects for postoperative pain management in patients undergoing open gynecologic abdominal surgery. Materials and Methods: Our prospective, randomized and double-blind study was planned after the decision of the Ethics Committee of the Faculty of Medicine of Çukurova University and the written informed consent of the patients were obtained. 80 patients with ASA scores of 1 and 2, aged between 18-69 and undergoing gynecological abdominal surgery were included in the gynecology and obstetrics clinic. The patients were randomly and double-blindly divided into 4 groups as erector spinae plane block (Group E), quadratus lumborum block (Group Q), transversus abdominis plane block (Group T), and control group (Group K). In the patients who underwent general anesthesia, after the completion of surgery and before extubation: In Group E: ESP block was applied with a total of 40 ml of 0.25% bupivacaine (20 ml for each side) at the T12 level bilaterally. In Group Q: bilateral anterior QL block was applied with a total of 40 ml of 0.25% bupivacaine (20 ml for each side) between the psoas major and quadratus lumborum muscles. In Group T: bilateral TAP block was applied with a total of 40 ml of 0.25% bupivacaine (20 ml for each side) to the anatomic neurofascial area between the internal oblique and transversus abdominis muscles. In Group K: Only routine intravenous patient-controlled analgesia protocol was applied. All patients were allowed to use patient-controlled morphine. Demographic data of the patients, hemodynamic data at postoperative 1, 2, 6, 12, and 24th hours, morphine consumption with the PCA method, VAS values at rest and with movement, emergency analgesic (meperidine) use, patient satisfaction scores, and side effects were recorded. Results: The demographic and hemodynamic data of the groups were similar. It was found that the pain scores at rest and with movement were significantly lower in the E group compared to the Q and T groups at the 1st and 2nd hours postoperatively, but the morphine consumption was similar between the block groups. It was found that the need for emergency analgesics was statistically significantly lower in Group E, Group Q and Group T at the 1st hour compared to the control group, whereas patient satisfaction scores and side effects did not show statistically significant differences between the groups. Although lower VAS and morphine consumptions were determined in the block-applied groups compared to the control group without block, no statistical difference was detected in terms of morphine consumption between the block-applied E, Q and T groups. Conclusion: It was concluded that the erector spinae plane block caused lower pain scores compared to the quadratus lumborum block and transversus abdominis plane block for postoperative pain management in patients undergoing open abdominal gynecological surgeries, but there was no significant difference between the block groups in terms of postoperative morphine consumption. Keywords: Erector spinae plane block, quadratus lumborum block, transversus abdominis plane block, bupivacaine, morphine, patient-controlled analgesia