Efficacy of Quadratus Lumborum Block for Postoperative Pain Management in Single-Port Total Laparoscopic Hysterectomy: A Randomized Observer-blinded Controlled Trial

Background and Objectives: Quadratus lumborum block (QLB) is a regional anesthesia technique widely utilized in multimodal analgesia strategies for abdominal surgeries. While a few studies have investigated its efficacy in multiport total laparoscopic hysterectomy (TLH), its effectiveness in single-port TLH remains uncertain. This study aimed to evaluate whether QLB reduces opioid consumption and postoperative pain in patients undergoing single-port TLH. Materials and Methods: This randomized, controlled, observer-blinded trial included 64 patients undergoing elective single-port TLH. Participants were randomly allocated to either the QLB group (n = 27) or the control group (n = 29). QLB was performed bilaterally under ultrasound guidance after surgery. The primary outcome was cumulative fentanyl consumption within 24 hours postoperatively. Secondary outcomes included pain scores at predefined intervals, time to first opioid demand, the incidence of postoperative nausea and vomiting (PONV) and other complications. Results: The 24-hour cumulative fentanyl consumption, which was the primary outcome, did not differ significantly between the QLB group 470 [191.6, 648.1] mcg and the control group 342.8 [220, 651] mcg (P = 0.714). Additionally, cumulative fentanyl consumption at other time points, including 2h, 4h, 8h, 12h, 32h, and 48h, as well as in the PACU, also showed no significant differences between the two groups. Pain scores measured at these time points, along with the time to first bolus on demand, similarly showed no significant differences between the groups. Conclusions: QLB did not significantly reduce opioid consumption or pain scores in patients undergoing single-port TLH.