Erector Spinae Plane Versus Quadratus Lumborum Blocks for Pain Management After Total Abdominal Hysterectomy

Comparative Efficacy of Erector Spinae Plane and Quadratus Lumborum Blocks in Managing Postoperative Pain for Total Abdominal Hysterectomy: A Randomized Controlled Trial

TAH, being a large scale gynaecological operation, is a construction bound to cause serious postoperative pain to the patient in that the procedure will inevitably entail massive tissue dissection. Management of this postoperative pain is of utmost significance because poor analgesia may lead to delayed mobilization of the patient, long duration of hospitalization and also general increase in the morbidity of postoperative period. Traditionally, in these facilities, opioid analgesics are the most common and the most popular means of controlling postoperative pain. Nevertheless, the varied and pervasive use of opioids is largely constrained by its well-reported, dose-dependent systemic adverse effects. Nausea, vomiting, sedation, and respiratory depression are complications that severely degrade the recovery process of the patient and reduce his or her satisfaction.

Patients who met the inclusion criteria were recruited in the trial after getting approval from the Hospital Ethical Review Committee and REU CPSP. Demographic information such as age, height, weight, body mass index as well as the functional classification (ASA) was documented on a pre-made proforma. Patients were randomized into two groups using a computer-generated randomisation process.

Group A: Received an ultrasound-guided erector spinae plane block at the T9-T10 level using 20 ml of 0.25% bupivacaine.

Group B: Received an ultrasound-guided posterior quadratus lumborum block using 20 ml of 0.25% bupivacaine.

A qualified anaesthesiologist performed each block in aseptic settings prior to surgery. Standardised general anaesthesia was administered to each patient. The Visual Analogue Scale (VAS) was used to quantify pain at rest and on coughing at 2, 6, 12, 18, and 24 hours. Patents with VAS score more than 4, were given rescue analgesia and the cumulative amount of analgesics used in the first 24 hours as well as the time of the first rescue analgesia were recorded. Patient satisfaction with pain treatment as well as adverse effects such nausea, vomiting, and hypotension were tracked for a duration of 24 hours after the surgery

Inclusion Criteria:

Patients aged 35-60 years. ASA physical status I or II. Elective Total Abdominal Hysterectomy under General Anesthesia.

Exclusion Criteria:

Allergy with local anesthetics. Infection in the injection site. Coagulopathy or anticoagulant use. Morbid obesity (BMI > 35 kg/m²).