Effects of Erector Spinae Plane Block and Transmuscular Quadratus Lumborum Block on Postoperative Opioid Consumption in Total Laparoscopic Hysterectomy: A Randomized Controlled Clinical Trial

Introduction: Total laparoscopic hysterectomy (TLH) is a common surgical procedure that is frequently associated with substantial postoperative pain. As part of multimodal analgesia, the erector spinae plane block (ESPB) and transmuscular quadratus lumborum block (TQLB) have been demonstrated to be effective. This study aimed to evaluate whether ESPB and TQLB reduce postoperative pain and opioid consumption after TLH.

Methods: A total of 90 female patients undergoing TLH were randomized to receive either ESPB, TQLB, or no intervention before general anesthesia. All patients received a patient-controlled sufentanil analgesia postoperatively. Postoperative pain and sufentanil consumption were evaluated. The primary outcome was cumulative sufentanil consumption at 12 h postoperatively.

Results: The cumulative sufentanil consumption at 12 h postoperatively was significantly lower in Group ESPB than in Group CON after Bonferroni correction (median [interquartile range], 0 [0, 4] μg vs. 6 [0, 10] μg; median difference = - 3; 95% confidence interval, - 6-0; P = 0.010). There were no significant differences between Group TQLB and CON (0 [0, 4] μg vs. 6 [0, 10] μg; P = 0.098) or between the two block groups (P = 1.000). When compared with Group CON, ESPB and TQLB persistently reduced pain scores until 6 and 4 h after surgery, respectively (P < 0.05). However, no significant differences were found in pain scores between the two block groups.

Conclusions: ESPB and TQLB improved the quality of multimodal analgesia for TLH. ESPB may be more favorable due to the prolonged period of analgesia and decreased opioid consumption after TLH.

Clinical trial registration: Chinese Clinical Trial Registry: ChiCTR2100048165, Registry URL: http://www.chictr.org.cn/showproj.aspx?proj=129578 . Date of registration: July 4, 2021. The patient enrollment began on July 12, 2021.