Effectiveness of Combined Fascial Plane Blocks for Postoperative Pain in Gynecologic Oncology Surgery

Postoperative Analgesic Efficacy of Combined Fascial Plane Blocks After Gynecologic Oncologic Surgery

The goal of this prospective observational study is to compare the effectiveness of different postoperative analgesic techniques in patients undergoing major abdominal surgery for gynecologic oncology.

The main question is whether the combination of TAP block with Quadratus Lumborum Block (QLB) or Rectus Sheath Block (RSB) provides superior pain relief compared to TAP block alone.

All blocks were performed as part of routine clinical anesthesia practice according to the attending anesthesiologist's judgment. No randomization, allocation, or study-directed intervention was performed.

Patients were classified into three groups based on the block type they received during standard care:

Group 1: TAP Block Only

Group 2: TAP + QLB Combination

Group 3: TAP + RSB Combination

Postoperative data, including pain scores (VAS), opioid consumption, sedation level, heart rate, blood pressure, nausea/vomiting, and length of hospital stay, were collected prospectively.

The study aims to determine which block combination provides the best postoperative pain control and recovery profile in patients undergoing gynecologic oncology surgery.

This study is a prospective observational research designed to evaluate the postoperative analgesic effectiveness of different combinations of fascial plane blocks in patients undergoing gynecologic oncology surgery.

All blocks (Transversus Abdominis Plane [TAP] block, Quadratus Lumborum Block [QLB], and Rectus Sheath Block [RSB]) were performed as part of routine clinical anesthesia practice according to the attending anesthesiologist's preference.

No intervention, randomization, or protocol-directed procedure was applied for research purposes. After data collection, patients were classified into three groups based on the block type they had received in standard care:

TAP block only

TAP + QLB combination

TAP + RSB combination

The study prospectively compared postoperative pain scores (VAS), opioid consumption, time to mobilization, bowel function recovery, and length of hospital stay among these groups to determine the most effective analgesic strategy within routine practice.

This observational design reflects real-world anesthesia management and does not involve any experimental or interventional component.

Inclusion Criteria

• Age 18 years or older.
• ASA physical status I-IV.
• Scheduled for major gynecologic oncology surgery (endometrial cancer, ovarian tumor, or cytoreductive surgery).
• Undergoing general anesthesia.
• Planned postoperative abdominal fascial plane block for pain management (TAP, TAP + QLB, or TAP + RSB).
• Able to provide written informed consent.

Exclusion Criteria

• Refusal to participate or inability to provide informed consent.
• Emergency surgery.
• Known allergy or contraindication to local anesthetics.
• Infection at the block site.
• Coagulopathy or anticoagulant use that contraindicates regional anesthesia.
• Pre-existing chronic pain conditions or chronic opioid use.
• Severe hepatic or renal insufficiency.
• Cognitive impairment that prevents reliable pain assessment.