Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Analgesia After Laparoscopic Colorectal Surgery

Figures

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  Figure 1. Ultrasound QL block approach: the needle is advanced in an anterolateral-to-posteromedial direction under US guidance to ensure precise localization. Bilateral type 3 (anterior) QL blocks were administered, with the injectate deposited at the fascial plane between the anterior border of the QLM and the PMM (from the authors’ collection). The arrow indicates the direction and the site of injection for the local anesthetic.

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  Figure 2. US TAP block approach: in the TAP group, the linear probe was placed in the transverse plane at the midaxillary line between the lower costal margin and iliac crest. When the EOM, IOM, and TAM were observed, a 20-gauge, 100 mm needle (Stimuplex® Ultra 360®; B.Braun, Mihela Olita, Fundeni Clinical Institute, Bucharest, Romania, Affiniti 70, Philips Ultrasound from Fundeni Clinical Institute, Bucharest, Romania) was advanced using an in-plane technique in an anteromedial to posterolateral direction toward the TAP (the fascial plane between the IOM and TAM) (from the authors’ collection).

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  Figure 3. Q-Q plot reflects total opioid consumption in the first 24 h between the two groups with a median 12 mg in the QL group vs. 18 mg in the TAP block. p < 0.001 and Q-Q plot for equivalent non-opioid consumption was lower in the QL group vs. the TAP group. p < 0.00. In the QL group, the requirement for first non-opioid intravenous was 16 h with a median of 14–18, reduced significantly as compared to the TAP group’s block, which also offers adequate analgesia, with the need for the earlier administration of non-opioid intravenous analgesia, respectively, at 8 h post operation, p < 0.001.

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  Figure 4. Opioid consumption. The figure illustrates a significant reduction in cumulative opioid consumption within the first 24 h post operation in patients receiving a quadratus lumborum (QL) block compared to those with a transversus abdominis plane (TAP) block.

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  Figure 5. Pain scores (VAS) at rest and during coughing effort in the first 48 h post operation. (A): VAS at rest. (B): VAS during coughing. Data are presented as median, range, and interquartile range. * p < 0.001. QL: quadratus lumborum; TAP: transversus abdominis plane; VAS: visual analog scale.