Comparison of USG Guided Erector Spinae block and QuadratusLumborum block in abdominal surgeries. A case series
Dr Sahajananda H, Dr Amod K S, Dr Navyashree K S
RAJARAJESWARI MEDICAL COLLEGE AND HOSPITAL
Effective postoperative analgesia after open abdominal surgeries is important because it enables early ambulation and helps in managing acute pain which is the most common complaint in patients undergoing these major surgeries.. Different modes of postoperative analgesia are epidural analgesia, PCA, I V analgesics, Nerve blocks.
The quadratus lumborum block (QLB) is an abdominal truncal block for analgesia after abdominal surgery and is known to alleviate somatic pain in both upper and lower abdomen. The QLB performed uses a fascial compartment path to extend the distribution of local anesthesia into the abdominal wall and paravertebral space. (Blanco etal)
The erector spinae plane (ESP) block is a recently described regional anesthetic technique for providing thoracic analgesia when performed at the level of the T5. LA injected into the fascial plane deep to the erector spinae muscle spreads in a craniocaudal fashion. Coupled with the fact that the erector spinae muscle and ESP extend down to the lumbar spine, this suggests that the ESP block could result in both visceral and somatic abdominal analgesia if the injection were performed at a lower thoracic level of the T7-8transverse process for relieving visceral abdominal pain following bariatric surgery. (Forrero etal)
The objective of our study is to compare USG guided Erector Spinae Plane block and Quatratous Lumborum block using 0.5% ropivacaine in abdominal surgeries, in terms of analgesia, and the time of first use of rescue analgesia, and the total requirement of analgesia in first 24hours, 48hours, 72hours. Patient comfort during the procedure.
methods and materials
A hospital based prospective randomized comparative case series was conducted after obtaining ethical committee clearance by Dr Sahajananda and Dr Amod et al in a group of 50 patients of ASA 1-3 who came for abdominal surgeries under GA, with either erector spinae plane(ESP) or quatratus lumborum(QL) block. Out of which 13 were excluded because of exclusion criteria and 7 denied the procedure. They were allocated to one of the two groups, by simple closed envelope method, Group ESP and QLB. They received 0.5% of ropivacaine according to their body weight, with divided the dose into equal halves for both the sides. Both intra and postoperative vitals monitored and analgesia was recorded using VAS scoring.
Authors do not have any financial gain from any of the products used in the study.
Stastical analysis: Data presented as a mean and standard deviation. The t-test was used to examine the difference between the means. Stastical significance was acceoted for the P-value of <0.05
results and discussion
A total of 50 patients were assessed, 13 came in exclusion criteria and 7 declined the procedure. 30 patientts were included in the study.
The two groups were comparable in demographics and mean duration of surgery. The intra operative and post-operative vitals were comparable.
Both ESP and QL blocks were effective in providing analgesia for the abdominal surgeries as per VAS score; there was a minimal difference in the period of analgesia and the first rescue analgesia usage. ESP block was statistically better to QL block with minimal difference.