Ultrasound-Guided Anterior Quadratus Lumborum Block Versus Transversalis Fascia Plane Block for Postoperative Analgesia in Minimally Invasive Colorectal Surgery: A Multicenter Randomized Controlled Trial

Objective: This study aimed to compare the efficacy and safety of ultrasound-guided quadratus lumborum block (QLB) versus transversus abdominis plane block (TAPB) in laparoscopic colorectal cancer surgery within an Enhanced Recovery After Surgery (ERAS) protocol. Methods: A two-center, prospective, randomized controlled trial was conducted with 182 patients (80 QLB, 102 TAPB), of whom 114 were matched via propensity score analysis (57 per group). Both groups received standardized anesthesia and postoperative analgesia. Primary outcomes included intraoperative remifentanil consumption and postoperative pain scores (VAS). Secondary outcomes encompassed hemodynamic stability, time to first flatus, ambulation, hospital stay, and adverse events. Results: QLB significantly reduced intraoperative remifentanil use (P = 0.0138) and provided superior early postoperative analgesia (lower VAS scores at 15 min, 6 h, and 12 h; P < 0.05). Despite delayed first flatus (58.49 ± 53.06 vs. 34.34 ± 19.74 hours, P = 0.002), QLB shortened hospital stays (median 5.60 vs. 8. 00 days, P = 0.029). Hemodynamics and adverse events were comparable between groups. Conclusion: QLB outperformed TAPB in opioid-sparing, early pain relief, and recovery acceleration, aligning with ERAS goals. Its broader nerve blockade may delay gastrointestinal recovery but ultimately enhances overall outcomes. Multicenter validation and long-term follow-up are warranted.