Anterior Quadratus lumborum block versus modified perichondrial thoracoabdominal nerve block (m-TAPA) for postoperative analgesia following laparoscopic cholecystectomy: a randomized controlled trial.

backgroundQuadratus lumborum block (QLB) and modified thoracoabdominal nerves block through perichondrial approach (m-TAPA) can be used for postoperative analgesia in laparoscopic cholecystectomies (LC). The aim of this study is to evaluate the analgesic efficacy of anterior QLB and m-TAPA during the first 24 hours postoperatively.

methodsThis study was designed as a randomized, prospective, single-blinded trial. Preoperatively, patients were divided into two groups: Group QLB (n=55) and Group m-TAPA (n=53). The anterior QLB was applied to Group QLB, while the m-TAPA was applied to the other group. After the blocks were administered, the dermatome areas covered at the 20th and 30th minutes were evaluated using a cold test. Intraoperative remifentanil consumption was recorded, while Numerical Rating Scale scores at rest (rNRS) and during movement (dNRS), opioid consumption, time to first rescue analgesic use, and complications were evaluated during the first 24 postoperative hours.

resultsThere was no statistically significant difference between the groups in terms of total analgesic consumption during the first 24 hours, rNRS and dNRS values at hours 1, 4, 8, 12, and 24, time to first rescue analgesic use, intraoperative remifentanil consumption and complications. When comparing dermatome involvement between the groups, it was observed that dermatome coverage in the m-TAPA group was mostly distributed in the T7-T10 dermatomes, while in the QLB group, it was mostly distributed in the T10-L1 dermatomes.

conclusionWe believe that both anterior QLB and m-TAPA can be used as part of opioid-free multimodal analgesia for postoperative analgesia during the first 24 hours in LC.