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OP054 Combined trans-muscular QLB and sacral ESB versus intrathecal morphine for peri-operative analgesia in patients undergoing open gynaecological oncological surgery: An open label prospective randomized non-inferioriority trial
  1. Debesh Bhoi1,
  2. Raga Brindha Balaji2,
  3. Anjolie Chhabra2,
  4. Ravindra Kumar Pandey3,
  5. Jyotsna Punj2 and
  6. Bikash Ranjan Ray2
  1. 1Anaesthesiology,Pain Medicine And Critical Care, All India Institute Of Medical Sciences, New Delhi, India
  2. 2Anaesthesiology,Pain Medicine And Critical Care, All India Institute Of Medical Sciences, New Delhi, India
  3. 3Anaesthesiology,Pain Medicine And Critical Care, All India Institute Of Medical Sciences, New delhi, India


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Background and Aims Gynecological oncology surgery is associated with large abdominal incisions, extensive dissection, and a more pronounced inflammatory response with a more challenging pain profile. The current study hypothesized that the analgesic efficacy of combined quadratus lumborum block (QLB) and sacral erector spinae block (ESB) is non-inferior to intrathecal morphine(ITM) in patients undergoing open gynecological oncological surgery with midline incision.

Methods After getting IEC approval 84 ASA 1&2 patients aged 18-65 years scheduled for open gynecological surgery were randomized to receive ITM 200mcg (Group A) or bilateral QLB (20 ml 0f 0.25% ropivacaine with adrenaline 1: 2,00,000 on each side) and 10 ml on each side for sacral ESB (Group B). The primary objective was to compare the 24-hour morphine consumption. Sensory assessment, time to first rescue, VAS score at different time intervals, quality of recovery score, and 48-hour analgesics consumption were secondary objectives.

Results Median 24-hour morphine consumption was comparable with 18 mg (IQR 3.5- 26) in group A and 11 mg (IQR 5 – 24) in group B. The difference between the mean was 4.54 with 95% CI (-1.16 to 10.24). The non-inferiority margin was 5 and the 95% confidence interval is crossing 0 proving the non-inferiority. The VAS score at rest and movement was comparable between the two groups, however at 48 hrs (movement) group B showed a statistically significant reduction.

Abstract OP054 Figure 1

CONSORT diagram

Abstract OP054 Table 1

Perioperative analgesic consumption

Abstract OP054 Figure 2

Non-inferiority margin

Conclusions Combined QLB with sacral ESB is non-inferior to ITM in terms of perioperative analgesia and quality of recovery in patients undergoing gynecological oncology surgery

  • Quadratus lumborum block
  • sacral erector spinae block
  • intrathecal morphine
  • gynecological oncology surgery

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