Comparative Efficacy of Ultrasound-Guided Quadratus Lumborum Block Versus Alternative Fascial Plane Blocks for Postoperative Analgesia Following Hysterectomy: A Systematic Review and Meta-Analysis.

Abstract

Objective: The primary aim was to compare the efficacy of the quadratus lumborum (QL) block with alternative fascial plane blocks for postoperative analgesia following hysterectomy, while secondary aims were to compare total 24-h analgesic consumption, postoperative pain scores at different time intervals, and the incidence of postoperative nausea and vomiting (PONV) between the QL block and comparator groups.

Methods: Electronic databases were systematically searched for studies that compared bilateral ultrasound-guided single-injection QL block to no block or other fascial plane blocks in hysterectomy surgeries. The QL block was compared with other fascial plane blocks, including transversus abdominis plane (TAP), oblique subcostal TAP (OSTAP), erector spinae plane (ESP), and combined TAP with ilioinguinal/iliohypogastric nerve block. The methodological quality of the included studies was assessed using the RoB 2.0 risk-of-bias tool. All outcomes were pooled using the Mantel-Haenszel method and random-effect model.

Results: After screening 946 relevant articles, 15 RCTs were included in this meta-analysis. The QL block significantly prolonged the time to first rescue analgesic request compared to the TAP block in the abdominal hysterectomy subgroup (MD 244.77 [95% CI: 191.98 to 297.56], I ² = 89%; GRADE evidence-"high") and the laparoscopic hysterectomy subgroup (MD 443.15 [95% CI: 56.37 to 829.93], I ² = 98%; GRADE evidence-"high"). Regarding the 24-h total analgesic requirement, the QL block significantly reduced its consumption than the TAP block in both the abdominal (MD -2.64 [95% CI: -4.19 to -1.09], I ² = 93%; GRADE evidence-"moderate") and the laparoscopic hysterectomy subgroup (MD -6.65 [95% CI: -7.39 to -5.91], I ² = NA due to n = 1; GRADE evidence-"moderate"). The risk of PONV did not differ significantly between the QL block and placebo in abdominal hysterectomy (RR 2.48 [95% CI: 0.50 to -12.35], I ² = 0%; GRADE evidence: "moderate") and laparoscopic hysterectomy arm (RR 0.78 [95% CI: 0.50 to -1.22], I ² = 44%; GRADE evidence: "moderate"). The QL block did not show significant difference in risk of PONV than the TAP block across both the abdominal (RR 0.59 [95% CI: 0.25 to 1.40], I ² = 0%; GRADE evidence: "moderate") and laparoscopic hysterectomy subgroups (RR 0.86 [95% CI: 0.30 to 2.45], I ² = 0%; GRADE evidence: "moderate").

Conclusion: The QL block provides superior postoperative analgesia compared with the TAP block in patients undergoing abdominal and laparoscopic hysterectomy.