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Background and Aims We aimed to prospectively compare the effects of Oblique Subcostal Transversus Abdominis Plane (OSTAP) block and Transmuscular Quadratus Lumborum (TQL) block on postoperative analgesia and quality of recovery in gynecological laparoscopic surgery, using a randomized controlled, double-blind approach. We hypothesized that TQL block would provide effective analgesia in gynecological laparoscopic surgeries, thereby reducing need for analgesics.

Methods 68 patients undergoing gynecological laparoscopic surgery were prospectively evaluated and randomized into two groups: OSTAP group (n=34) and TQL group (n=34). Following the block, anesthesia induction was administered. Postoperative rest and movement VAS scores, consumption of paracetamol and tramadol within the first 24 hours, time to first requirement of paracetamol and tramadol, nausea-vomiting, mobilization and discharge times, preoperative-postoperative 24th hour QoR-15 scores were recorded. Patient-surgeon satisfactions were measured with a 5-point Likert scale.

Results In TQL group, significantly lower VAS scores were observed at rest and in movement at the 6th hour and in movement before discharge (p=0.019, p=0.004, p=0.023, respectively). However no differences were found between the groups at other time intervals. The number of patients requiring paracetamol, time to first requirements of paracetamol and tramadol, total doses of tramadol were similar between groups. Conversely, total dose of paracetamol and number of patients requiring tramadol were significantly higher in OSTAP group (p=0.002, p=0.006, respectively). There were no differences in nausea-vomiting, need for antiemetics, preoperative-postoperative QoR-15 scores, discharge times and patient-surgeon satisfactions.

Conclusions TQL block has been shown to be more effective than OSTAP block in managing postoperative pain, underscoring its importance in multimodal analgesia protocols.