Oblique Subcostal Transversus Abdominis Plane Block versus Transmuscular Quadratus Lumborum Block for Postoperative Analgesia and Quality of Recovery in Laparoscopic Gynecological Surgery: A Prospective Randomized Controlled Double-Blind Trial

Background During laparoscopic gynecological surgeries, trocar incisions, pneumoperitoneum and distention of the anterior abdominal wall can cause postoperative pain. Inadequate pain management can increase the risk of postoperative complications. The present study compared the effects of oblique subcostal transversus abdominis plane (OSTAP) block and transmuscular quadratus lumborum (TQL) block on postoperative analgesia and quality of recovery (QoR) in patients undergoing laparoscopic gynecological surgery. Methods A total of 73 patients were enrolled in this prospective, randomized, controlled, double-blind study. The patients were randomly allocated to the OSTAP group (n = 36) or the TQL group (n = 37). General anesthesia was induced following bilateral block administration with 20 ml of 0.25% bupivacaine. The primary outcome was the total consumption of paracetamol and tramadol within the first 24 h postoperatively. Secondary outcomes included the time to first analgesic requirement, visual analog scale (VAS) scores at rest and during movement, and Quality of Recovery-15 (QoR-15) scores preoperatively and 24 h postoperatively. Results The total paracetamol consumption was significantly lower in the TQL group (p = 0.002), whereas total tramadol consumption was similar between the groups. The TQL group had significantly lower VAS scores at rest and during movement at 6 h postoperatively and during movement before discharge (p = 0.019, p = 0.004, p = 0.023, respectively). The groups were similar regarding time to the first analgesic requirement and QoR-15 scores preoperatively and 24 h postoperatively. Conclusions The TQL block reduces postoperative analgesic requirements compared to the OSTAP block. However, both blocks have similar effects on QoR. Trial registration: ClinicalTrials.gov, NCT06017401. Registered on August 20, 2023. Retrospectively registered.