Quadratus Lumborum Block vs Erector Spinae Plane Block in Abdominal Hysterectomy
Condition: Gynecologic Disease
MeSH terms: Genital Diseases, Female
Study type: Interventional

Summary: 
      Postoperative pain following abdominal hysterectomy is a challenging concern as some patients
      suffer acute pain that could let to chronic pain over time following the surgery. Epidural
      analgesia which is the gold standard for postoperative pain management in abdominal surgeries
      including abdominal hysterectomy has side effects such as hypotension, hematoma, motor
      weakness of lower limbs, paresthesia, intrathecal placement of the epidural catheter and
      urinary retention that could prolong hospital stay. Since high frequency ultrasound machines'
      usage has increased in postoperative analgesia management, ultrasound guided fascial plane
      blocks has been performed by clinicians with high success rate. To avoid possible
      complications of epidural catheter placement and epidural analgesia, various techniques has
      been applying for an analgesic effect close to the effectiveness of epidural analgesia. These
      techniques include transversus abdominis plane block, rectus sheath block, wound infiltration
      of local anesthetics, erector spinae plane block and quadratus lumborum plane block. However,
      each of the plane blocks has limitations individually which prevent them to be the unique
      analgesic technique for postoperative analgesia following abdominal surgery. As far as the
      authors knowledge, there's no reported study which compares ultrasound guided erector spinae
      plane block versus ultrasound guided quadratus lumborum type III block (anterior quadratus
      lumborum block) as a preemptive analgesia technique in patients undergoing abdominal
      hysterectomy.
    

Detailed description: 
      Hysterectomy is one of the most frequently performed surgical procedures in the United
      States. The management of postoperative pain in gynecologic surgery is challenging.

      Due to side effects of opioids such as nausea and vomiting, titration of opioid dosage for
      postoperative pain is difficult and effective postoperative analgesic regimes is needed.
      Ultrasound guided regional anesthesia techniques such as erector spinae plane block and
      quadratus lumborum block for postoperative pain management has an acceleration in usage as
      ultrasound guidance makes the interventions safer and easier to perform, and they contribute
      to better pain control and pain experience. Ultrasound guided quadratus lumborum block for
      postoperative pain management after abdominal surgery was firstly conceived by Blanco in 26th
      European Society of Regional Anesthesia Congress in 2007 as a variant of transversus
      abdominis plane (TAP) block. Later on he reported posterior quadratus lumborum block (QLB) in
      2013 which is known as QLB II. Børglum et. al described the transmuscular quadratus lumborum
      block (TQL or QLB III) in 2013 which is frequently performed in abdominal wall surgeries. QLB
      III, transmuscular quadratus lumborum block (TQL) and anterior quadratus lumborum block;
      these are all synonyms and refers to injection of local anesthetic into the anterior
      thoracolumbar fascia (TLF) which lays between quadratus lumborum muscle and psoas major
      muscle. Erector spinae plane block has being performed by clinicians for abdominal and
      thoracic surgeries since it was firstly described by Forero et al. in 2016 for analgesia in
      thoracic neuropathic pain. In this ultrasound guided technique local anesthetic is applied
      between the transverse process of the relevant thoracic or lumbar vertebrae and the erector
      spinae muscle which leads to the spread of the local anesthetic cephalad, caudally and
      through the paravertebral space. The investigators hypothesize that performing
      ultrasound-guided quadratus lumborum block will be more superior or equal to erector spinae
      plane block in providing postoperative analgesia for patients undergoing abdominal
      hysterectomy under general anesthesia.
    

Intervention name(s): No Block; Quadratus Lumborum Block Type III; Erector Spinae Plane Block
Intervention type(s): Other; Procedure; Procedure
Intervention description(s): The patients will receive general anesthesia.; Patients will receive ultrasound-guided quadratus lumborum block type III with 60 ml of bupivacaine 0.25% followed by general anesthesia.; Patients will receive ultrasound-guided erector spinae plane block type III with 60 ml of bupivacaine 0.25% followed by general anesthesia.
Other intervention name(s): Control Group; QLB III; ESPB
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The patients will be divided randomly by a computer-generated randomization table into three equal groups.
Masking: Double (Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Erector Spinae Plane Block; Quadratus Lumborum Block; Analgesia; Abdominal Hysterectomy; Ultrasound Guidance