Enhanced Postoperative Pain Management: A Comparative Analysis of Ultrasound-Guided Quadratus Lumborum Block Versus Intraperitoneal and Periportal Bupivacaine Infiltration Following Laparoscopic Cholecystectomy: A Randomized Double-Blind Study.

Background: Inadequately managed acute pain following abdominal surgery can lead to patient discomfort, anxiety, respiratory issues, delirium, myocardial ischemia, prolonged hospital stays, and persistent pain.

Objectives: This research compares the quadratus lumborum (QL) block to intraperitoneal and periportal bupivacaine infiltration for postoperative analgesia after laparoscopic cholecystectomy.

Methods: This randomized double-blind study included seventy patients aged 21 to 60 years, randomly selected from Ain Shams University Hospital between March 2022 and March 2023, scheduled for elective laparoscopic cholecystectomy. The patients were divided into two groups of 35 based on postoperative pain management: Group A received intraperitoneal and periportal infiltration, while group B underwent the QL block, with details on placement and duration.

Results: The results indicated a substantial decrease in Visual Analogue Scale (VAS) scores at 6 hours postoperatively, with group B exhibiting a median pain level of 3 [IQR 3 - 5] compared to group A's median of 5 [IQR 5 - 6], yielding a P-value of less than 0.001. The data indicate that group B had significantly enhanced postoperative analgesia within the initial 6 hours, both in a static condition and during movement. Moreover, patients in group B required fewer postoperative analgesics during the first 24 hours following surgery compared to group A.

Conclusions: Following laparoscopic cholecystectomy, the QL block proved more effective than intraperitoneal and periportal bupivacaine infiltration in reducing postoperative pain scores for 6 hours and in reducing total opioid and analgesic use for 24 hours postoperatively.