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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.
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
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