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Abstract
Introduction Postoperative pain after laparoscopic abdominal surgery remains complex. While lateral quadratus lumborum (QL) block and transversus abdominus plane (TAP) block are similar techniques, no studies have examined if one technique has greater dermatomal spread.
Methods Laparoscopic colorectal surgical patients were randomized to lateral QL or TAP blocks. Dermatomal anesthetic spread, as measured by loss of sensation to temperature in the postanesthesia care unit, was the primary outcome. If a clear level of dermatomal anesthesia could not be defined, the block was categorized as “indeterminate.” Secondary outcomes included opioid consumption, pain scores, and opioid-related side effects.
Results 153 patients completed the study (75 QL and 78 TAP). Mean (95% CI) number of dermatomes with loss of sensation to ice was greater in subjects randomized to QL (4.2 (3.7 to 4.8)) versus TAP (2.7 (2.2 to 3.2); p=0.0001), and the QL group was more likely to have loss of sensation above T8 (p=0.01) and T10 (p=0.02). Indeterminate block was more often noted with TAP blocks (p<0.0001). Opioid consumption at 24 hours, pain scores, and opioid-related side effects did not differ.
Discussion Compared with TAP blocks, QL blocks had greater dermatomal anesthesia spread and lower rates of an indeterminate block. However, differences in pain and opioid consumption were not noted. The clinical importance of these findings should be investigated in future trials.
Trial registration number NCT03490357.
- Anesthesia, Local
- Nerve Block
- Pain, Postoperative
- Pain Management
- Pain Perception
Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.
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Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.
Footnotes
X @RenukaGeorge, @SylviaHWilson
Contributors RMG conceived and presented the idea for IRB approval and is also the guarantor. SHW and JRMcS provided advice and insight into study design, protocol creation, data analysis, and edited final version of study write up. MG edited and wrote the paper. DAW advised on statistics for protocol creation and provided data analysis and writing for paper. All authors discussed the results and contributed to the final manuscript.
Funding This work was supported by internal departmental support (Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina). This project was also supported by the South Carolina Clinical & Translational Research Institute, Medical University of South Carolina’s CTSA, NIH/NCRR Grant Number 1UL1TR001450. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NCRR.
Competing interests All the authors declare that they do not have any competing interests with the production of this paper.
Provenance and peer review Not commissioned; externally peer reviewed.
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