Comparative Evaluation of Analgesic Efficacy and Recovery Outcomes: Anterior Quadratus Lumborum Block at the Lateral Supra-Arcuate Ligament Versus Transversus Abdominis Plane Block in Laparoscopic Partial Hepatectomy.

Abstract

Objective: A comparative assessment of analgesic effectiveness and recovery quality between the anterior quadratus lumborum block at the lateral supra-arcuate ligament (QLB-LSAL) and the transversus abdominis plane block (TAPB) in patients undergoing laparoscopic partial hepatectomy (LPH).

Method: A total of 56 patients scheduled for LPH were randomly allocated to either the QLB-LSAL group or the TAPB group in a 1:1 ratio. Patients in the QLB-LSAL group received bilateral anterior quadratus lumborum block at the lateral supra-arcuate ligament, while those in the TAPB group received bilateral subcostal transversus abdominis plane block before surgery. The primary outcome was the morphine equivalent consumption (MEC) at 24 hours postoperatively. Secondary outcomes included MEC at 48 and 72 hours, as well as numeric rating scale (NRS) pain scores at rest and during movement, recorded at 2, 4, 6, 12, 24, and 48 hours postoperatively. The quality of recovery was assessed using QoR-15 scores, measured 1 day before surgery and on the first and third postoperative days.

Results: The QLB-LSAL group demonstrated significantly lower MEC at 24, 48, and 72 hours postoperatively compared with the TAPB group. NRS scores for pain at rest and during movement were also significantly lower in the QLB-LSAL group at 2, 4, 6, 12, and 24 hours following surgery. In addition, the QoR-15 scores, which assess the quality of recovery, were significantly higher in the QLB-LSAL group compared with the TAPB group on both the first and third postoperative days.

Conclusion: The QLB-LSAL method provides superior analgesia and enhances recovery quality compared with the TAPB approach in patients undergoing LPH.