Comparison of the postoperative analgesic effect of transversus abdominis plan block and quadratus lumborum block: A prospective randomized study

Abstract

Background and aims: In this study, we aimed to compare the transversus abdominis plan block (TAP) and quadratus lumborum block (QL) efficacy for postoperative analgesia in patients undergoing varicocelectomy under spinal anesthesia.

Methods: American Society of Anesthesiologists (ASA) 1 and 2 patients, aged 18-45 years, who underwent varicocelectomy operation under elective conditions, were included. Eighty patients were divided into three groups as TAP group, QL group, and control group by prospective randomization. The patients were operated under spinal anesthesia. At the end of the operation, TAP was applied to the TAP group with a posterior approach using ultrasound (USG) in the supine position. To the QL group, the patient was placed in the lateral decubitus position and the lateral QL was applied via USG. No block type was applied to the control group. Patient-controlled analgesia (PCA) device containing tramadol was administered intravenously at the end of the surgery in all groups. Visual analogue scale (VAS) score was questioned at 0, 2, 4, 6, 8, 10, 12, 18, 24 h in the follow-up of the patients. Intravenous 1 g paracetamol was given over VAS 4. PCA usage time and usage amounts were recorded.

Results: As a result of comparing the groups according to the VAS scores at all hours were significantly different between the three groups (p < 0.001). There was a significant difference between the groups when comparing the number of PCA bolus administrations (p < 0.001). TAP and QL blocks significantly reduced the number of PCA bolus when compared with the control group (p < 0.001) but the number of PCA bolus was found to be similar between TAP and QL blocks (p > 0.05).

Conclusion: TAP and QL, which are administered to evaluate the effectiveness of postoperative analgesia in patients undergoing varicocelectomy under spinal anesthesia, are both effective in reducing pain scores and the amount of analgesia consumption.

Keywords: abdominal muscles; analgesia; anesthesia; pain; varicocele.

Figure 1

Ultrasound imaging of transversus abdominis plan block application. Eksternal Oblik, external oblique muscle; Internal Oblik, internal oblique muscle; Peritoneal Kavite: peritoneal cavity; Transversus Abdominis, transverse abdominis muscle.

Figure 2

Quadratus lumborum block USG image. EO, external oblique muscle; IO, internal oblique muscle; TA, transverse abdominis muscle; USG, ultrasound.

Figure 3

Consort flow diagram. QL, quadratus lumborum block; TAP, transversus abdominis plane block.

Figure 4

Comparison of groups according to the VAS score (median). QL, quadratus lumborum block; TAP, transversus abdominis plane block; VAS, visual analog scale.

Figure 5

Comparison of the groups according to the PCA bolus number value (median). PCA, patient‐controlled analgesia; QL, quadratus lumborum block; TAP, transversus abdominis plane block.

Figure 6

Comparison of groups in terms of patient satisfaction (n). QL, quadratus lumborum block; TAP, transversus abdominis plane block.