Published: 2021-04-23

A comparison of transversus abdominis plane block with quadratus lumborum block for post-operative analgesia in abdominal hysterectomy: a retrospective observational study

Sumit Kumar Gupta, Ritu Grewal, Sirisha Anne, Arpit Garg


Background: Abdominal hysterectomy is the most common surgery performed in Indian Women. Recent advances in Regional Anaesthesia especially ultrasonography-guided truncal blocks for postoperative analgesia are now being used for patient comfort and faster times for discharge of the patients. This study compares the ultrasonographic guided transversus abdominis plane block and quadratus lumborum blocks for patients undergoing abdominal hysterectomy under general anaesthesia. Aim of the study was to compare the efficacy of transversus abdominis plane block and quadratus lumborum blocks in patients undergoing abdominal hysterectomy.

Methods: A retrospective observational study of prospectively collected data was performed. A total of 111 patients of American Society of Anesthesiologists (ASA) II and III gradings were enrolled in the study who had received either transversus abdominis plane block or quadratus lumborum blocks. Visual analog scale (VAS) scores and use of rescue analgesia was studied between the two groups. The data obtained were analysed using the students t-test and Mann Whitney U Test.

Results: The demographic profile was similar between the 2 groups. The study showed that patients who received the quadratus lumborum block had a greater analgesia after 6 hours and had lower analgesic requirements compared to those who received transversus abdominis block (TAP) block. TAP block was however effective in the initial post-operative period.

Conclusions: In patients undergoing abdominal hysterectomy quadratus lumborum block may be preferred over TAP block for post-operative analgesia.


Transverse abdominis plane block, Post op analgesia, Quadratus lumborum block

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Preeti RH, Chothani C, Gupta SD. Predictors of hysterectomy amongst married women 15-49 years in India. Reprod Health. 2018;15(1):3.

Nirboer TE, Johnson N, Lethalry A, Tevender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological diseases. Cochrane Database Syst Rev. 2009;3:CD003677.

Wilmore DW, Kehlel H. Management of patients in fast track surgery. BMJ. 2001;322:473-6.

Jorgenson H, Formsgaardd JS, Dirk J, Wetterler J, Andreasson B, Dall JB. Effect of peri and post-operative epidural anaesthesia on pain and GI function after abdominal hysterectomy. Br J Anaesth. 2001;87(4):577-83.

Corney JJ, Mc Donell JG, Ochana A, Bhinder R, Laffey JG. The transversus abdominis plane block provides effective post-operative analgesia in patients undergoing total abdominal hysterectomy. Anaesthesia. 2008;107:2056-60.

Belavy Dl, Cowlishaw PJ, Howes M, Philips F. Ultrasound guided transversus abdominis plane block for analgesia after Caesarean delivery. Br J Anaesth. 2009;103(5):726-30.

Blanco R. TAP block under ultrasound guidance: The description of a “non-pops technique”. Reg Anaesth Pain Med. 2007;32:130.

Aksu C, Gurkan Y. Ultrasound guided Quadratus Lumborum Block for post-operative analgesia in pedriatic ambulatory inguinal hernia repair. J Clin Anaesth. 2018;46:77-8.

Akerman MI, Pejcic NZ, Velickovic I. A review of the quadratus lumborum block and ERAS. Front Med (Lausanne). 2018;26(5):44.

Elsharkawy H, El-Boghdadly K, Kolli S. Injectate spread following anterior sub-costal and posterior approaches to the quadratus lumborum block. Eur J Anaesthesiol. 2017;34:587-95.

Chakarborty A, Goswami J, Patro V. Ultrasound guided continuous quadratus lumborum block for post-operative analgesia in paedriatic patient. Anaesth Analgesia. 2015;4:34-6.

Blanco R, Ansari T , Riad W, Shetty N. Quadratus lumborum block versus Transversus abdominis block for post operative pain after Caserean delivery : A randomized controlled trial. Reg Anaesth Pain Med. 2016;41:757-62.

Yousef NK. Quadratus lumborum Block versus Transversus Abdominis plane Block in Patients Undergoing total Abdominal Hysterectomy: A randomized Prospective Controlled Trial. Anesth Essays Res. 2018;12(3):742-7.

Verma K, Malawat A, Jethava D, Jethava DD. Comparison of transversus abdominis plane block and quadratus lumborum block for post-caesarean section analgesia: A randomised clinical trial. Indian J Anaesth. 2019;63:820-6.

Carnney J, Finnerty O, Rauf J, Bergin D, Laffey JG, McDonnell JG, et al. Studies on spread of local anaesthetic solution in transversus abdominis plane blocks. Anaesthesia. 2011;66:1023-30.

Mourouchi T, Iwasaki S, Yamakage M. Chronological changes in ropivacaine concentration and analgesic effects between transversus abdominis plane block and rectus sheath block. Reg Anesth Pain Med. 2015;40:568-71.

Oksuz G, Bilal B, Gurukan Y, Urfalioglu A, Arslan M, Gigi G, et al. Quadratus lumborum block versus transversus abdominis plane block in children undergoing lower abdominal surgeries: A randomized controlled trial. Reg Anesth Pain Med. 2017;42:674-9.

Baidya DK, Maitra S, Arora MK, Agarwal A. Quadratus lumborum block: An effective method of Perioperative analgesia in children undergoing Pyeloplasty. J Clin Anesth. 2015;27:694-6.