scholarly journals Transmuscular quadratus lumborum block versus oblique subcostal transversus abdominis plane block for analgesia in laparoscopic hysterectomy: a randomised single-blind trial

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e043883
Author(s):  
Lvdan Huang ◽  
Liangyu Zheng ◽  
Jingxiong Zhang ◽  
Xiaona Zhu ◽  
Linmin Pan ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Outcome Measures ◽  
Visceral Pain ◽  
Laparoscopic Hysterectomy ◽  
Transversus Abdominis ◽  
Secondary Outcome ◽  
Transversus Abdominis Plane ◽  
Quadratus Lumborum ◽  
Single Blind ◽  
Single Blind Trial

ObjectiveThe transmuscular quadratus lumborum (TQL) block and the oblique subcostal transversus abdominis plane (OSTAP) block both contribute to multimodal analgesia after laparoscopic surgery. The objective of this study was to compare the analgesic effects of the TQL block versus OSTAP block after laparoscopic hysterectomy.DesignProspective single-centre randomised single-blind trial.SettingUniversity-affiliated hospital.ParticipantsPatients aged between 18 and 65 years scheduled for laparoscopic hysterectomy.InterventionsPatients were randomised into two groups (1:1 ratio) and received bilateral TQL block or bilateral OSTAP block with 0.375% ropivacaine 20 mL on each side before surgery.Primary and secondary outcome measuresThe primary outcome measure was the cumulative morphine dose in the first 24 hours. The secondary outcome measures were the morphine consumption at each time interval after surgery, the time from the end of surgery to the first need for morphine, the Numerical Rating Scale (NRS) scores for visceral and incisional pain intensity, and the incidence of adverse events.ResultsThe cumulative morphine dose was significantly lower in the TQL group than in the OSTAP group (17.2 (12.5) vs 26.1 (13.3) mg, p=0.010). Compared with the OSTAP group, the morphine doses from 6 to 12, 12 to 18, and 18 to 24 hours were significantly lower, the time of first need for morphine was significantly longer and the NRS scores for visceral pain intensity were significantly lower in the TQL group.ConclusionCompared with the OSTAP block, the TQL block reduced morphine consumption and provided better visceral pain relief with a longer duration of effect after laparoscopic hysterectomy.Trial registration numberChinese Clinical Trial Registry (ChiCTR1800017995); pre-results.

scholarly journals Quadratus Lumborum and Transversus Abdominis Plane Blocks and Their Impact on Acute and Chronic Pain in Patients after Cesarean Section: A Randomized Controlled Study

2021 ◽  
Vol 18 (7) ◽  
pp. 3500
Author(s):  
Michał Borys ◽  
Aleksandra Zamaro ◽  
Beata Horeczy ◽  
Ewa Gęszka ◽  
Marek Janiak ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Postoperative Pain ◽  
Cesarean Section ◽  
Pain Intensity ◽  
Hospital Discharge ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Randomized Controlled ◽  
Quadratus Lumborum ◽  
Persistent Postoperative Pain

Background: Severe postoperative pain is a significant problem after cesarean sections. Methods: This study was a randomized, controlled trial of 105 patients conducted in two hospitals. All patients were anesthetized spinally for elective cesarean section. Each participant was randomly allocated to one of three study groups: the quadratus lumborum block (QLB) group, the transversus abdominis plane block (TAPB) group, or the control (CON) group. The primary outcome of this study determined acute pain intensity on the visual analog scale (VAS). The secondary outcomes determined morphine consumption and chronic pain evaluation according to the Neuropathic Pain Symptom Inventory (NPSI) after hospital discharge. Results: At rest, the pain intensity was significantly higher in the CON group than in the QLB and TAPB groups at hours two and eight. Upon activity, the pain in the control subjects was more severe than in the QLB and TAPB groups in three and two of five measurements, respectively. Moreover, morphine consumption was significantly lower in the QLB (9 (5–10)) and TAPB (10 (6–14)) groups than in the CON (16 (11–19)) group. Persistent postoperative pain was significantly lower in the QLB group than in the CON group at months one and six following hospital discharge. Conclusions: Both the QLB and TAPB can improve pain management after cesarean delivery. Moreover, the QLB might reduce the severity of persistent postoperative pain months after cesarean section.

scholarly journals The Effectiveness of Transversus Abdominis Plane and Quadratus Lumborum Blocks in Acute Postoperative Pain Following Cesarean Section—A Randomized, Single-Blind, Controlled Trial

2021 ◽  
Vol 18 (13) ◽  
pp. 7034
Author(s):  
Michał Borys ◽  
Beata Potręć-Studzińska ◽  
Paweł Kutnik ◽  
Justyna Sysiak-Sławecka ◽  
Elżbieta Rypulak ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Cesarean Section ◽  
Pain Intensity ◽  
Controlled Trial ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Acute Postoperative Pain ◽  
Randomized Controlled Studies ◽  
Quadratus Lumborum ◽  
Significant Difference

Acute pain intensity related to cesarean section (CS) may be extensive and is often underestimated. This may influence mothers’ quality of life and their children’s development. Regional analgesia techniques that include transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) have proven their efficacy in the postoperative period after CS. Although several randomized controlled studies and one meta-analysis have investigated the utility of TAPB and QLB in the reduction of acute and chronic pain after CS, only one study directly compared both types of regional blocks and revealed superiority of QLB over TAPB. Our study aimed to reevaluate the effectiveness of transversus TAPB and QLB in controlling acute postoperative pain after CS. We recruited 197 women with singleton pregnancies undergoing CS under spinal anesthesia. The patients were randomized to receive either TAPB or QLB after CS. The acute postoperative pain was evaluated using the visual analog scale (VAS) at 2, 4, 8, 12 and 24 h after the operation. No significant difference in acute postoperative pain intensity between the groups was found. The patients who received TAPB had a higher demand for supplemental morphine injections (p < 0.039). In our study, none of the evaluated regional blocks demonstrated an advantage over the other regarding acute postoperative pain management.

Transversus Abdominis Plane and Rectus Sheath Blocks

2021 ◽  
pp. 81-88
Author(s):  
Natalea Johnson ◽  
Jorge A. Pineda
Keyword(s):  
Abdominal Wall ◽  
Umbilical Hernia ◽  
Visceral Pain ◽  
Rectus Sheath ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Nerve Blocks ◽  
Rectus Sheath Block ◽  
Intercostal Nerves

Chapter 9 discusses truncal peripheral nerve blocks, which are utilized for supplemental analgesia for abdominal surgeries by providing local anesthesia to the anterior abdominal wall. These blocks are adjuvants because they will not block visceral pain. Unilateral analgesia to the skin, muscles, and parietal peritoneum of the abdominal wall is achieved. The transversus abdominis plane block (TAP) reliably provides analgesia to the lower abdominal wall in the T10–L1 distribution. Rectus sheath blocks anesthetize the terminal branches of the lower thoracic intercostal nerves and provide midline analgesia from the xiphoid process to the umbilicus. Surgical indications for TAP blocks include laparotomies, laparoscopies, inguinal hernia repairs, and appendectomies. Rectus sheath block indications include midline surgeries such as single-port appendectomies and umbilical hernia repairs.

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