Quadratus Lumborum Versus Transversus Abdominis Plane Nerve Block: A Comparison Study

Quadratus Lumborum Versus Transversus Abdominis Plane Nerve Block: A Comparison in Regional Anesthesia Techniques With an Enhanced Recovery After Surgery Pathway

The Transversus Abdominis Plane (TAP) block is the current standard of care for patients undergoing laparoscopic abdominal surgeries with the Enhanced Recovery After Surgery (ERAS) Protocol. The Quadratus Lumborum (QL) is another established abdominal fascial plane block that is comparable in procedure and risks and may potentially be more beneficial. The study compares the two blocks in hopes of establishing a new standard of care for patients undergoing laparoscopic abdominal surgeries with the ERAS protocol.

The Transversus Abdominis Plane (TAP) block is the current standard of care for patients undergoing laparoscopic abdominal surgeries with the Enhanced Recovery After Surgery (ERAS) Protocol. The Quadratus Lumborum (QL) is another established abdominal fascial plane block that is comparable in procedure and risks and may potentially be more beneficial. The study compares the two blocks in hopes of establishing a new standard of care for patients undergoing laparoscopic abdominal surgeries with the ERAS protocol.

• Compare QL and TAP blocks cephalad spread via mapping in the Postoperative Acute Care Unit (PACU) within 6 hours after block placement.
• Compare efficacy of blocks via Visual Analogue Scale (VAS) pain scores in PACU and postoperative day (POD) 1.
• Compare amount of opioid pain medications consumed within 24 hours after block. Hypothesis
• The QL block will prove superior to the TAP block in both cephalad spread and pain control for abdominal surgery patients and decrease the amount of opioid pain medications required while in effect up to 24 hours after surgery.
• The quadratus lumborum will have increased cephalad spread. We predict mapping will show greater (2 or more dermatomal levels) or equal analgesic coverage by the QL block when compared to the TAP block.

Inclusion Criteria:

• • Patients scheduled for laparoscopic abdominal surgery as posted by the surgeon

  • Part of the ERAS protocol as listed by the surgeon
  • Age 18 years and older
  • Elective procedure

Exclusion Criteria:

• • Patient inability to consent

  • Patient inability to communicate for data collection
  • Conversion from laparoscopic to open case
  • Local anesthetic allergy
  • Weight less than 50 kg
  • Anatomical variation making block visualization unlikely
  • Inability to cooperate with block
  • Surgery posted longer than 6 hours
  • Known preoperative substance abuse
  • Chronic opioid use > 3 months
  • Patient exhibits dependence on opioids Daily opioid use for pain control