Comparison of Analgesia Efficacy of Transversus Abdominis Plane Block and Posterior Approach Quadratus Lumborum Block
Condition: Acute Post-operative Pain; Nerve Block; Prostate Cancer
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Prostate cancer is the second most common cancer and the fifth in cancer-related deaths. Open
      radical retropubic prostatectomy is the most common surgical treatment for localized prostate
      cancer. Open radical retropubic prostatectomy is associated with moderate pain. Severe pain
      in the postoperative period affects the length of hospital stay and morbidity. Multimodal
      analgesia applications for the management of postoperative pain are the main component of
      post-surgical recovery. Different analgesia modalities, including systemic opioid use and
      neuraxial analgesia, have been used for pain control after retropubic radical prostatectomy.
      Side effects of systemic and intrathecal opioids limit the potential benefits of these
      agents. Transversus abdominis plane block and quadratus lumborum block are blocks that can be
      used for postoperative analgesia in the abdominal and pelvic regions. There is no study in
      the literature comparing the efficacy of these two blocks for postoperative analgesia in open
      radical retropubic prostatectomy and their effects on narcotic consumption.
    

Detailed description: 
      Scope: Open radical retropubic prostatectomy operation is associated with moderate
      postoperative pain and affects hospital stay and morbidity. Nerve blocks used for
      postoperative analgesia are one of the components of multimodal analgesia.

      Transversus abdominis plane block (TAP) is a regional block (T7-L1) that blocks the sensory
      afferents of the anterior abdominal wall. It was first introduced as an anatomical
      landmark-based technique through Petit's lumbar triangle. Since then, the ultrasound-guided
      block technique has been defined and the effectiveness of this block in postoperative pain
      control in abdominal and gynecological surgeries has been demonstrated. The sensory
      distribution of TAP block includes the incisional pain of open prostatectomy. TAP block
      technique has been shown to be a safe and effective method of postoperative analgesia in
      various general surgery, urological surgery, plastic surgery and pediatric surgery
      operations. In addition, postoperative pain management after lower abdominal surgeries has
      been recommended as part of ERAS protocols.

      Quadratus lumborum block (QL) is used as one of the postoperative pain methods after
      abdominal surgery in all age groups. It has been reported that QL block with a posterior
      approach extends more easily into the thoracic paravertebral space or the thoracolumbar plane
      and can create analgesia from T 7 to L 1. The use of posterior QL (QL-2) blocks for
      postoperative analgesia after open retropubic prostatectomy operations has not been studied
      before and it is not known which one is superior.

      The primary aim of this study was to compare the analgesic efficacy of transversus abdominis
      plane block and posterior approach quadratus lumborum block and opioid consumption within 24
      hours postoperatively. The secondary aim is to determine whether there is a difference in
      terms of time to first analgesic consumption, duration of sensory block, opioid-related side
      effects (postoperative nausea and vomiting, itching, sedation), patient satisfaction, and
      complications related to the block.
    

Intervention name(s): transversus abdominis plane block,
Intervention type(s): Procedure
Intervention description(s): 2 different plan blocks; 1. transversus plane block 2. quadratus lumborum plane block
Other intervention name(s): quadratus lumborum plane block
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: patients who underwent open retropubic prostatectomy
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: quadratus lumborum block, transversus abdominis plane block