Ultrasound-guided quadratus lumborum block versus thoracic paravertebral block in gynecological cancer surgery: a prospective randomized trial

Abstract

Background & Objectives: In the event that gynecologic cancer surgery (GC surgery) is going to be accompanied with extreme pain, many localized blocks will be provided. The quadratus lumborum block, often known as a QLB, is a fascial plane block that was developed relatively recently for the therapy of post-abdominal surgery discomfort. In the current study, a comparison is made between the effectiveness and safety of thoracic paravertebral block (TPVB) and quadratus lumborum block (QLB) in patients undergoing GC surgery. Methodology: In this prospective comparative randomized trial, fifty patients with scheduled GC surgery were split evenly between two groups: QLB group (n = 25) to receive bilateral QLB type-2, or TPVB group (n = 25) to receive TPVB. The VAS scores were recorded at 1, 2, 4, 6, 12, and 24 h following surgery, and served as the key indicator of patient outcomes. Secondary outcomes were; the time to first request for the analgesic, the patient satisfaction, and the total morphine consumed as rescue analgesic in 24 h. Results: At 2, 6, 12 and 24 h, the VAS scores of the QLB group were significantly lower than those of TPVB group. Only 12 (48%) of the QLB group patients required rescue morphine, compared to all patients in the TPVB group requiring it. QLB group showed more dermatomal distribution in comparison to the TPVB group. It took the TPVB group a much shorter time to demand their first painkiller (P = 0.001), and they also took significantly more total morphine (P = 0.001). An increased number of people in the QLB group reported satisfaction as a result of taking the analgesic. Conclusion: Quadratus lumborum block is a promising technique for postoperative analgesia for patients undergoing gynecological cancer surgery. This block provides relatively prolonged duration of pain relief, compared to thoracic paravertebral block. Abbreviations: FLACC - Face, Legs, Activity, Cry, Consolability scale; GC - gynecological cancer; QLB - quadratus lumborum block; QLB2 - Bilateral quadratus lumborum block; TPVB - thoracic paravertebral block; VAS - visual analogue scale Keywords: Quadratus lumborum block; Thoracic paravertebral block; Gynecological cancer surgery; Postoperative pain management. Citation: Hussein FG, El Samahy KA, Abd Elghaffar EM, Mahran EAH, Hassan ME, Thabet TS. Ultrasound-guided quadratus lumborum block versus thoracic paravertebral block in gynecological cancer surgery: a prospective randomized trial. Anaesth. pain intensive care 2024;28(3):436−445; DOI: 10.35975/apic.v28i3.2287 Received: September 03, 2023; Revised: October 11, 2023; Accepted: April 08, 2024