Comparative efficacy of erector spinae plane and quadratus lumborum blocks in managing postoperative pain for total abdominal hysterectomy: A randomized controlled trial

Comparative efficacy of erector spinae plane and quadratus lumborum blocks in managing postoperative pain for total abdominal hysterectomy: A randomized controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative efficacy of erector spinae plane and quadratus lumborum blocks in managing postoperative pain for total abdominal hysterectomy: A randomized controlled trial Onur BARAN, Ayhan ŞAHİN This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3933636/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Effective postoperative pain management after total abdominal hysterectomy is crucial for patient recovery and satisfaction. This study compared the efficacy of the erector spinae plane block and quadratus lumborum block in reducing postoperative opioid consumption and pain in patients with total abdominal hysterectomy. Methods: In this prospective, randomized controlled trial, 90 patients undergoing total abdominal hysterectomy were divided into three groups: ESPB, QLB, and control. The primary outcome was postoperative opioid consumption. Secondary outcomes included pain scores assessed by the visual analog scale at predetermined times and the incidence of postoperative nausea and vomiting. Statistical significance was determined using analysis of variance, the Mann–Whitney U test, and the Kruskal–Wallis test. Results: The ESPB and QLB groups showed a significant reduction in postoperative opioid consumption compared with the control group (p < 0.001 for both comparisons). Pain scores were significantly lower in the ESPB and QLB groups than in the control group at 2, 6, and 24 h postoperatively (p < 0.001 at each time point). The incidence of postoperative nausea and vomiting was lower in the ESPB and QLB groups than that in the control group; however, this difference was not statistically significant (p = 0.029). No significant differences were observed in opioid consumption or pain scores between the two groups. Conclusions: Both the erector spinae plane and quadratus lumborum blocks effectively reduced postoperative opioid consumption and pain in patientswith total abdominal hysterectomy. These techniques offer a promising approach for postoperative pain management, potentially reducing the need for opioids. IRB Number: 2022.206.11.07 Clinical Trial Registry Number: NCT05675657 Anesthesia Erector spinae plane block Quadratus lumborum block Total abdominal hysterectomy Postoperative pain Opioid consumption Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Regarding frequency of application, cesarean section is the most commonly performed obstetric surgery, followed by hysterectomy[ 1 , 2 ]. Total abdominal hysterectomy (TAH) is a serious major surgical procedure that negatively affects postoperative recovery and is associated with severe postoperative pain [ 3 , 4 ]. Severe pain after TAH should be treated using a multimodal pain control strategy. Limiting opioid consumption, which has many side effects such as nausea, vomiting, and respiratory depression, and relieving pain by using the least amount of opioids is one of the most important goals of anesthesiologists [ 5 ]. Although the quadratus lumborum block (QLB), an abdominal wall block applied under ultrasound guidance, was first defined by Blanco et al. [ 6 ] as a variation of the transversus abdominis plane block (TAPB), various application approaches to this block have been defined over time [ 7 , 8 ]. It is performed by applying a local anesthetic to the anterior, posterior, or lateral quadratus lumborum muscle, and the nomenclature is based on the targeted anatomical location [ 9 ]. The anterior QLB is aimed at delivering high-volume local anesthetic to the interfascial plane between the quadratus lumborum muscle and the psoas muscle, and this approach is practical in providing postoperative pain control in many studies [ 9 – 12 ]. Since its description by Forero et al. [ 13 ], the erector spinae plane block (ESPB) has proven effective in providing postoperative analgesia and reducing opioid consumption after numerous surgical procedures [ 14 – 17 ]. The main goal of this block is to block the ventral and dorsal branches of the relevant spinal nerves by applying a high volume of local anesthetic between the tip of the transverse process of the relevant vertebra and the erector spinae muscle under ultrasound guidance [ 18 ]. In this study, we hypothesized that the ESPB and QLB could reduce opioid consumption by providing multimodal analgesia after TAH. In this context, the primary outcome was the 24-hour cumulative opioid consumption in the ESPB, QLB, and control groups, and the secondary outcomes were the postoperative visual analog scale (VAS) score, postoperative first rescue analgesic time, and the presence of nausea and vomiting. Methods This prospective, double-blind, randomized controlled study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol, approved by the Tekirdağ Namık Kemal University Ethics Committee, is registered with ClinicalTrials.gov on 09/01/2023 (NCT05675657). Written informed consent was obtained from all patients before their inclusion in the study. Patients who were scheduled to undergo elective TAH under general anesthesia by the Department of Gynecology and Obstetrics at Tekirdağ Namık Kemal University Hospital, Tekirdağ, Turkey between January 15, 2023, and July 15, 2023, were included in the study. Patients aged 18–75 years with American Society of Anesthesiologists (ASA) physical scores of I and II were included in the study. Patients who met the following exclusion criteria were excluded from the study: patients who did not agree to participate in the study, those with body mass index (BMI) > 35 kg/m 2 , patients younger than 18 years of age, patients older than 75 years of age, patients with uncontrolled systemic disease, those with whom cooperation could not be ensured, such as mental retardation, patients with low cardiac capacity, patients with a history of allergy to planned and possible drugs, coagulopathy, local infection, or addiction to opioids. The patients were randomized into three groups using the sealed envelope method through a computer-based program (https://www.randomizer.org), with equal numbers of patients in each group. Researchers who applied the blocks to the patients and those who administered anesthesia and followed the patients during the postoperative period differed. Therefore, researchers other than those who applied the blocks to patients did not know which group the patients belonged to. The blinding was achieved in this manner. All patients underwent surgery under general anesthesia. Before general anesthesia, the patients were evaluated in the pre-anesthesia room according to the group to which they were randomized. According to the sealed envelope system, the patient was taken directly to the operating room and preparations for general anesthesia were initiated if the patient was in the control group. If the patient was in the ESPB or QLB group, they were placed in the area reserved for peripheral nerve blocks. Patients underwent 3-channel electrocardiogram (ECG), noninvasive blood pressure, and peripheral oxygen saturation monitoring in a particular area reserved for peripheral nerve block. A total of 0.02 mg.kg -1 intravenous (iv) midazolam was administered along with saline infusion sufficient to ensure patency of the intravenous vascular access. An ultrasound machine (Esaote, MyLab Six, Genova, Italy) with linear and curved probes was installed and used for the block groups. All patients underwent surgery under general anesthesia. From the moment the patient entered the operating room, 3-way ECG, noninvasive blood pressure, and peripheral oxygen saturation monitoring were performed. Following the induction with 2.5 mg.kg -1 propofol, one mcg.kg -1 fentanyl, and 0.5 mg.kg -1 rocuronium, the patients were successfully intubated, and anesthesia was maintained with sevoflurane and 50% oxygen-air mixture. All patients received a remifentanil infusion titrated to 0.1–1 mcg.kg.min -1 . Thirty minutes before the end of the surgery, 1 g of paracetamol and ondansetron were administered. After successful recovery from anesthesia and extubation, the patients were transferred to a postanesthesia care unit (PACU). A tramadol-based patient controlled analgesia (PCA) device was connected to the patients in the PACU for postoperative analgesia. The PCA device contained 3 mg.ml -1 tramadol, was set to 3.5 ml bolus, had a 20-minute lockout, and had a 4-hour limit of 35 ml. During the postoperative period, 1 g of paracetamol was administered every 6 h. In cases where the VAS score was four or above, diclofenac 75 mg was ordered, followed by 100 mg tramadol as rescue analgesia when a VAS score of 4 or above was still observed 30 min later. Diclofenac was administered at a maximum dose of 150 mg/day, and tramadol at a maximum of 400 mg/day hours. During this process, the VAS score, number of postoperative nausea and vomiting (PONV) episodes, and first rescue analgesic time were recorded in the PACU and ward at 2, 6, 12, and 24 h by an assistant independent of the study. ESPB technique For ESPB, the patient was placed in the prone position. After skin sterilization, a high-frequency linear ultrasound probe was placed perpendicular to the midline at the T9 vertebra level. After the spinous process level was identified on the ultrasound screen, the probe was rotated 90 °clockwise or counterclockwise, such that the identifying light remained on the cranial side and shifted 2–3 cm laterally from the midline. The paraspinal anatomical structures were identified, and the transverse process and erector spinae muscle were observed posteriorly. A 22-gauge 100 mm sonovisible peripheral nerve block needle was advanced craniocaudally towards the transverse process under ultrasound guidance, keeping the needle tip visible at all times. When the needle tip touched the transverse process, it was slightly withdrawn, and 1–2 ml of saline was administered for testing (Fig. 1A). If it was observed that the interfascial plane between the erector spinae muscle and the transverse process was separated, 30 ml bupivacaine at 0.25% concentration was given in divided doses and intermittently with negative aspiration, if no blood was observed (Fig. 1B). The same procedure was performed on the contralateral side at the same vertebral level under the same conditions. QLB technique For the QLB, the patient was first placed in a lateral decubitus position with the side chosen for the block on top. By ensuring all aseptic conditions, the transverse processes of the L4 vertebra, psoas muscle, quadratus lumborum, and erector spinae muscles were detected with a low-frequency curvilinear probe placed between the iliac crest and the 12th rib at the midaxillary line (Fig. 2A). Using a 22-gauge 100 mm sonovisible peripheral nerve block needle under ultrasound guidance, keeping the needle tip constantly visible, the quadratus lumborum muscle was passed transmuscularly in the posteroanterior plane, and 1–2 ml of saline was administered to the interfascial plane between the psoas muscle and the quadratus lumborum muscle, following negative blood aspiration. After the separation in the interfascial plane was observed, 30 ml 0.25% bupivacaine was applied with intermittent aspiration to prevent intravenous injection. Local anesthetic spread was observed between the quadratus lumborum and psoas muscle (Fig. 2B). The same procedure was performed on the contralateral side, under identical conditions. Control group interventions In the control group, patients were transferred from pre-anesthesia to the operating room without block interventions. Outcome measurements The primary outcome was the 24-hour cumulative opioid consumption in the ESPB, QLB, and control groups. The secondary outcomes were the postoperative visual analog scale score, postoperative first rescue analgesic time, and the presence of nausea and vomiting, recorded in the PACU and ward at 2, 6, 12, and 24 h by an assistant independent of the study. Sample size calculation The power analysis for our primary hypothesis, which investigated "the effect of the ESPB and QLB on postoperative opioid consumption in patients undergoing TAH," was conducted with a focus on the variable of postoperative opioid consumption to determine whether there was a significant effect between different treatment groups. Owing to the lack of directly comparable studies in the literature and the inability to conduct a pilot study, the power analysis was based on the assumptions of a medium effect size (Cohen's d of 0.5), 5% risk of Type I error (alpha), and 80% power (1-beta error, Type II error). The analysis concluded that approximately 14 participants per group (ESPB, QLB, control) were required, making 42 participants sufficient. The sample size was determined to ensure adequate power to test the primary hypotheses. However, our study included 90 participants (30 in each group). Statistical analysis Descriptive statistics were used to summarize the data. For continuous (numerical) variables, depending on the distribution, either mean ± standard deviation or median with minimum and maximum values were presented in a tabular format. Categorical variables are summarized as counts and percentages. The normality of the numerical variables was assessed using the Shapiro–Wilk, Kolmogorov–Smirnov, and Anderson–Darling tests. The Fisher–Freeman–Halton test was used to compare categorical variable differences across groups. Compared to two independent groups, the Mann–Whitney U test was used for numerical variables that did not follow a normal distribution. In comparisons involving more than two independent groups, the one-way analysis of variance (ANOVA) test was used for numerical variables that exhibited a normal distribution, while the Kruskal–Wallis H test was employed for those that did not exhibit a normal distribution. For multiple comparisons in parametric tests, either the Games–Howell or Tukey’s tests were used, whereas for non-parametric tests, the Dwass–Steel–Critchlow–Fligner test was applied. For within-group comparisons of pulse, mean arterial pressure, resting VAS score, and movement VAS score, the repeated measures ANOVA was used when numerical variables showed a normal distribution, and the Friedman test, a non-parametric version of repeated measures ANOVA, was employed otherwise. The Tukey test was used for parametric test methods, whereas the Durbin–Conover test was applied for non-parametric methods to identify differences between measurements. This study incorporated the Bonferroni correction to control for the possibility of false positives (Type I error) due to multiple comparisons. The Bonferroni correction was used to reduce the risk of false determination of significance in each of the multiple statistical tests. Our study measured two variables across three groups (ESPB, QLB, and control). These measurements were taken at six distinct time points to assess pulse and mean arterial pressure: pre-anesthetic, immediately post-induction, at the 1st-hour post-induction, at the 2nd-hour post-induction, at the end of the case, and in the postanesthesia care unit (PACU). Additionally, measurements were conducted at four different time points in the same three groups for the resting and moving VAS scores. We performed all possible pairwise comparisons among the three groups at each time point, resulting in three pairwise comparisons at each time point (ESPB-QLB, ESPB-control, and QLB-control). Consequently, with measurements repeated across six time points, the pairwise comparisons totaled 18 for pulse and mean arterial pressure. Similarly, for the resting and moving VAS scores, 12 pairwise comparisons were made, considering three pairwise comparisons across the four time points. After applying Bonferroni correction, the overall significance level of 0.05 was divided by 18 comparisons. Consequently, the new threshold for the significance of each comparison was set to p < 0.0028. A p-value below this threshold indicated statistical significance for the respective comparison. As mentioned above, the Bonferroni correction and the newly calculated significance threshold of p < 0.0028 were explicitly applied to the results presented in Table 2 and Table 3. These adjustments and thresholds are specific to the multiple time points, and group comparisons in this table and are not applicable to the analysis results in other study sections. Statistical analyses were performed using Jamovi (version 2.3.28) and JASP (version 0.17.3) software, and a significance level of 0.05 (p-value) was considered for all statistical analyses. Results In our study, 103 patients were screened, and 13 were excluded (Fig. 3). 90 participants were analyzed; the mean age was 47.7 ± 6.1 years. The mean BMI of the participants was 25.6 ± 3.1. The median block time for the procedure was 480 s. The median operative time was 122 min. Postoperative pain assessed using the PACU VAS, had a median score of 2. The total amount of postoperative opioids administered had a median of 52.5 mg. The median time to first rescue analgesic requirement was 16 h. Regarding PONV, most patients (76.7%, n = 69) did not experience adverse events. The study revealed no significant differences between the groups in terms of BMI, block time, or operative time (p > 0.05). However, a significant age disparity was observed, with patients undergoing the ESPB being significantly older than those receiving the QLB (p = 0.003). Regarding postoperative pain management, both the PACU VAS scores and total postoperative opioid analgesic doses were comparable between the ESPB and QLB groups (p > 0.05). Conversely, these measurements were significantly higher in the control group than in the ESPB and QLB groups (p < 0.05). The time to the first rescue analgesic requirement was significantly shorter in the control group than in the ESPB and QLB groups (p < 0.001 and p = 0.001, respectively). Simultaneously, it was similar between the ESPB and QLB groups (p = 0.978). Lastly, the incidence of PONV was comparable between the ESPB and QLB groups but significantly higher in the control group (p = 0.029) (Table 1). Our study found no significant differences between the groups in terms of pulse rate and mean arterial pressure at any measurement point (both p > 0.0028). In the measurements of resting VAS scores, significant differences emerged between the groups at the postoperative 2nd and 24th hours (p < 0.001 and p = 0.002, respectively). Specifically, the VAS scores were significantly higher in the control group than in the ESPB group at the postoperative 2nd hour. No significant differences were observed in the other pairwise comparisons. At the postoperative 24th hour, there were no significant differences in the pairwise comparisons between the groups. When analyzing the movement VAS scores, significant differences were observed at all measurement points between the groups (p < 0.0028 for each). Movement VAS scores at the postoperative 2nd, 6th, and 24th hours were notably higher in the control group than in both the ESPB and QLB groups (p 0.05). At the postoperative 6-h mark, no significant differences were found in the pairwise comparisons of the movement VAS scores (each p > 0.028). In the intragroup comparisons within the ESPB group, no significant changes were observed in the pulse rate and resting and movement VAS scores (each p > 0.0028). However, a significant change was observed in the mean arterial pressure over time (p < 0.001). Specifically, the mean arterial pressures at the 1st and 2nd hour post-induction were significantly lower than the baseline values (each p 0.0028). No significant changes in the pulse rate and resting or movement VAS scores were observed in the control group (each p > 0.0028). However, a significant difference was found in mean arterial pressure (p < 0.001), with immediate post-induction mean arterial pressures being significantly lower than the pre-anesthetic values (p < 0.001) (Fig. 4 and Fig. 5) (Table 2 and Table 3). Discussion Our study's primary focus was to evaluate the analgesic efficacy of the ESPB and QLB in patients undergoing TAH, with particular emphasis on postoperative opioid consumption. The results indicated that both ESPB and QLB were effective in reducing postoperative pain and opioid requirements compared with the control group, with no significant difference between the ESPB and QLB groups. These findings are consistent with those of recent studies that have explored the effectiveness of ESPB and QLB in various surgical contexts. For instance, Jiang et al. [ 19 ] demonstrated that both the ESPB and the transmuscular QLB improved multimodal analgesia quality in total laparoscopic hysterectomy, suggesting their potential to reduce opioid consumption. Similarly, our study found comparable efficacy between ESPB and QLB, reinforcing that both techniques are viable options for postoperative pain management in patients with TAH. Moreover, the study by Zanfini et al. [ 20 ] on postoperative analgesia after cesarean section using ESPB and QLB found no significant difference in total morphine consumption between the two groups, aligning with our findings of comparable opioid consumption between ESPB and QLB groups. These findings further support the idea that both blocks effectively manage postoperative pain during abdominal surgery. Interestingly, a study on laparoscopic liver resection [ 21 ] also reported similar postoperative analgesia between the ESP and QL blocks, which aligns with our findings. This consistency across different types of surgeries suggests a broader applicability of these blocks in various surgical procedures. Furthermore, a study comparing the ESPB and QLB in open nephrectomy [ 22 ] reported similar outcomes in terms of morphine consumption and pain scores, corroborating our findings regarding the efficacy of both blocks. A study on pediatric postoperative pain management [ 23 ] suggested that the QLB might provide more effective analgesia than the ESPB in specific contexts, indicating the need for further research to explore the differential effectiveness of these blocks in various patient populations and surgical procedures. In terms of the adjuvants used in ESPB, a study [ 24 ] highlighted the efficacy of dexmedetomidine over dexamethasone in enhancing the analgesic profile of ESPB. This finding suggests potential avenues for optimizing ESPB techniques, which could be relevant to future studies on TAH. Finally, a comparison between the QLB and TAPB [ 2 , 25 ] in patients with TAH showed that the QLB was more effective, reinforcing our study's findings regarding the efficacy of the QLB in managing postoperative pain in TAH. This study had some certain limitations. Even though the study was conducted prospectively and randomly, the patients were awake even under sedation during the block procedures. Although they did not know which block was performed, the patients may not be considered fully blinded. This situation was tried to be eliminated by ensuring that the people who followed the patients in the postoperative period did not know whether any blocks were applied to the patients. Conclusions Our study contributes significantly to the evidence supporting the ESPB and QLB as effective postoperative pain management strategies for patients with TAH. These findings align with existing literature, suggesting that both ESPB and QLB are viable options for reducing opioid consumption and managing postoperative pain during abdominal surgery. Future studies should explore the differential effects of these blocks on various patient demographics, surgical procedures, and the use of different adjuvants to optimize their analgesic efficacy. Abbreviations TAH: Total abdominal hysterectomy QLB: Quadratus lumborum block TAPB: Transversus abdominis plane block ESPB: Erector spinae plane block VAS: Visual analog scale ASA: American society of anesthesiologists BMI: Body mass index ECG: Electrocardiogram PACU: Postanesthesia care unit PCA: Patient controlled analgesia PONV: Postoperative nausea and vomiting Declarations Ethics approval and consent to participate This prospective, double-blind, randomized controlled study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol, approved by the Tekirdağ Namık Kemal University Ethics Committee (2022.206.11.07), is registered with ClinicalTrials.gov (NCT05675657). Consent for publication Written informed consent was obtained from all patients before their inclusion in the study. Availability of data and materials The data that support the findings of this study are available from the corresponding author upon reasonable request. Competing interests Not applicable Funding Not applicable Authors’ contributions OB and AŞ designed the study, performed blocks, followed the patients, analyzed the data and wrote the main manuscript text including tables and figures. All the authors reviewed the final version of the manuscript. Acknowledgements I very much appreciate Prof. Dr. Cavidan Arar who played a decisive role in this study. References Kamel AAF, Amin OAI, Ibrahem MAM. Bilateral Ultrasound-Guided Erector Spinae Plane Block Versus Transversus Abdominis Plane Block on Postoperative Analgesia after Total Abdominal Hysterectomy. Pain Physician. 2020;23(4):375–82. Shukla U, Yadav U, Singh AK, Tyagi A. Randomized Comparative Study Between Bilateral Erector Spinae Plane Block and Transversus Abdominis Plane Block Under Ultrasound Guidance for Postoperative Analgesia After Total Abdominal Hysterectomy. Cureus. 2022;14(5):e25227. Shukla U, Yadav U, Duggal J. A Comparative Study of Ultrasound-Guided Quadratus Lumborum Block and Transversus Abdominis Plane Block for Postoperative Analgesia Following Total Abdominal Hysterectomy. Cureus. 2023;15(3):e36412. Naaz S, Kumar R, Ozair E, Sahay N, Asghar A, Jha S, Akhil VP. Ultrasound Guided Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Post-operative Analgesia in Patients Undergoing Total Abdominal Hysterectomy. Turk J Anaesthesiol Reanim. 2021;49(5):357–64. Omara AF, Elbadry AA, Abo Hagar AM. Quadratus Lumborum Block Against Coupled Transversus Abdominis Block and Ilioinguinal/Iliohypogastric Nerve Blocks for Postoperative Analgesia After Total Abdominal Hysterectomy: A Randomized Controlled Trial. Anesth Pain Med. 2023;13(2):e134845. 271. Tap block under ultrasound guidance: the description of a no pops technique. Regional Anesthesia & Pain Medicine 2007, 32(Suppl 1):130. Blanco R, Ansari T, Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: A randomised controlled trial. Eur J Anaesthesiol. 2015;32(11):812–8. Børglum J, Moriggl B, Jensen K, Lønnqvist P-A, Christensen AF, Sauter A, Bendtsen TF. Ultrasound-guided transmuscular quadratus lumborum blockade. BJA: Br J Anaesth 2013, 111(eLetters Supplement). El-Boghdadly K, Elsharkawy H, Short A, Chin KJ. Quadratus Lumborum Block Nomenclature and Anatomical Considerations. Reg Anesth Pain Med. 2016;41(4):548–9. Zhao WL, Li SD, Wu B, Zhou ZF. Quadratus Lumborum Block is an Effective Postoperative Analgesic Technique in Pediatric Patients Undergoing Lower Abdominal Surgery: A Meta-Analysis. Pain Physician. 2021;24(5):E555–e563. Xiong H, Chen X, Zhu W, Yang W, Wang F. Postoperative analgesic effectiveness of quadratus lumborum block: systematic review and meta-analysis for adult patients undergoing hip surgery. J Orthop Surg Res. 2022;17(1):282. Uppal V, Retter S, Kehoe E, McKeen DM. Quadratus lumborum block for postoperative analgesia: a systematic review and meta-analysis. Can J Anesthesia/Journal canadien d'anesthésie. 2020;67(11):1557–75. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016;41(5):621–7. Koo CH, Lee HT, Na HS, Ryu JH, Shin HJ. Efficacy of Erector Spinae Plane Block for Analgesia in Thoracic Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth. 2022;36(5):1387–95. Liang X, Zhou W, Fan Y. Erector spinae plane block for spinal surgery: a systematic review and meta-analysis. Korean J Pain. 2021;34(4):487–500. Statistically significant but clinically unimportant: a systematic review and meta-analysis of the analgesic benefits of erector spinae plane block following breast cancer surgery. Regional Anesthesia & Pain Medicine 2021, 46(1):3. Viderman D, Aubakirova M, Abdildin YG. Erector Spinae Plane Block in Abdominal Surgery: A Meta-Analysis. Front Med 2022, 9. Kot P, Rodriguez P, Granell M, Cano B, Rovira L, Morales J, Broseta A, Andrés J. The erector spinae plane block: a narrative review. Korean J Anesthesiol. 2019;72(3):209–20. Jiang W, Wang M, Wang X, Jin S, Zhang M, Zhang L, Zhang Y, Wu Y. Effects of Erector Spinae Plane Block and Transmuscular Quadratus Lumborum Block on Postoperative Opioid Consumption in Total Laparoscopic Hysterectomy: A Randomized Controlled Clinical Trial. Pain Ther 2023. Zanfini BA, Di Muro M, Biancone M, Catarci S, Piersanti A, Frassanito L, Ciancia M, Toni F, Santantonio MT, Draisci G. Ultrasound-Guided Bilateral Erector Spinae Plane Block vs. Ultrasound-Guided Bilateral Posterior Quadratus Lumborum Block for Postoperative Analgesia after Caesarean Section: An Observational Closed Mixed Cohort Study. J Clin Med. 2023;12(24):7720. Kang R, Lee S, Kim GS, Jeong JS, Gwak MS, Kim JM, Choi GS, Cho YJ, Ko JS. Comparison of Analgesic Efficacy of Erector Spinae Plane Block and Posterior Quadratus Lumborum Block in Laparoscopic Liver Resection: A Randomized Controlled Trial. J Pain Res. 2021;14:3791–800. Onay M, Erdoğan Kayhan G, Özen A, Şanal Baş S, Yelken B. Comparison of ultrasound-guided quadratus lumborum block and erector spinae plane block in terms of their effects on postoperative pain in open nephrectomy. Minerva Anestesiol. 2023;89(1–2):32–9. Taman HI, LahloUb FM, Farid AM, Hegazy MA, Elshahawy ME, Elawady MS. Bilateral erector spinae plane block vs quadratus lumborum block for postoperative pain management after pediatric laparoscopic abdominal surgery: a randomized comparative study. Anaesth Pain Intensive Care. 2022;26(5):602–7. Mohammed Ali DS, Salama AM, Abaza KA, Ahmed FM. Dexamethasone versus Dexmedetomidine as Adjuvant to Bupivacaine in Ultrasound Guided Erector Spinae Plane Block for Analgesia in Total Abdominal Hysterectomy. Egypt J Hosp Med. 2022;88(1):4051–6. Alansary AM, Kamaly AM, Abdel Hamid HS, Aboelanean YM, Ezzat AW. Ultrasound-guided quadratus lumborum block versus transversus abdominis plane block in patients undergoing total abdominal hysterectomy. Ain-Shams J Anesthesiology. 2022;14(1):22. Tables Table 1 . Comparison of demographic and clinical characteristics among ESPB, QLB, and control Groups in a surgical patient population. Overall (n = 90) Groups p ESPB (n = 30) QLB (n = 30) Control (n = 30) Age (yr) ΙΙ 47.7 ± 6.1 49.9 ± 6.9 45.2 ± 3.6 48.1 ± 6.5 0.003 * BMI (kg/m 2 ) ΙΙ 25.6 ± 3.1 25.9 ± 3.4 25.8 ± 2.6 25.1 ± 3.2 0.583 * Block Time (s) ¶ 480.0 [147.0 – 900.0] 480.0 [147.0 – 600.0] 488.5 [300.0 – 900.0] - 0.212 † Operation Time (min) ¶ 122.0 [60.0 – 300.0] 134.5 [70.0 – 220.0] 132.5 [85.0 – 200.0] 120.0 [60.0 – 300.0] 0.530 ‡ PACU VAS Score ¶ 2.0 [0.0 – 4.0] 1.0 [0.0 – 3.0] 1.0 [0.0 – 3.0] 2.0 [1.0 – 4.0] 0.001 ‡ Postoperative Total Opioid (mg) ¶ 52.5 [10.5 – 105.0] 42.0 [21.0 – 63.0] 52.5 [10.5 – 63.0] 63.0 [31.5 – 105.0] <0.001 ‡ First Rescue Analgesic Need Hour (h) ¶ 16.0 [1.0 – 23.0] 19.0 [13.0 – 23.0] 19.0 [13.0 – 23.0] 4.5 [1.0 – 11.0] <0.001 ‡ Number of PONV ¶ 0.0 [0.0 – 1.0] 0.0 [0.0 – 1.0] 0.0 [0.0 – 1.0] 0.0 [0.0 – 1.0] 0.030 ‡ No ** 69 (76.7) 26 (86.7) †† 25 (83.3) †† 18 (60.0) ‡‡ 0.029 § Yes ** 21 (23.3) 4 (13.3) †† 5 (16.7) †† 12 (40.0) ‡‡ Table 1 compares the demographic and clinical characteristics among erector spinae plane block (ESPB), quadratus lumborum block (QLB), and control groups in a surgical patient population. The ΙΙ symbol represents mean ± standard deviation, and the ¶ symbol indicates median values with ranges [minimum-maximum]. Statistical analyses included one-way analysis of variance (ANOVA) ( * ), Mann–Whitney U test ( † ) , Kruskal–Wallis test ( ‡ ), and Fisher–Freeman–Halton test ( § ) to evaluate differences across the ESPB, QLB, and control groups. The ** symbol denotes the number and percentage of patients (n [%]). In the table, ' †† ' and ' ‡‡ ' indicate significant group differences identified in multiple comparison tests, providing insights into variations in factors such as age, body mass index (BMI), block time, operation duration, postanesthesia care unit (PACU) visual analog scale (VAS) score, total postoperative opioid consumption, time first to rescue analgesic requirement, and number of postoperative nausea and vomiting (PONV) episodes. Table 2. Comparative heart rate and mean arterial pressure analysis among the ESPB, QLB, and control groups. Groups p ESPB (n = 30) QLB (n = 30) Control (n = 30) Pulse (bpm) ΙΙ Pre-anesthetic 80.5 [56.0 – 109.0] 88.5 [66.0 – 121.0] 79.0 [50.0 – 110.0] 0.007 † Immediate post-induction 78.0 [55.0 – 109.0] 87.5 [70.0 – 116.0] 84.0 [56.0 – 124.0] 0.003 † 1 st hour post-induction 75.0 [50.0 – 95.0] 81.5 [61.0 – 94.0] 72.5 [57.0 – 104.0] 0.061 † 2 nd hour post-induction 76.5 [54.0 – 96.0] 80.5 [63.0 – 95.0] 75.0 [62.0 – 99.0] 0.281 † End of case 81.0 [60.0 – 96.0] 76.5 [61.0 – 92.0] 75.0 [62.0 – 116.0] 0.970 † PACU 76.5 [59.0 – 99.0] 74.0 [63.0 – 95.0] 69.5 [50.0 – 99.0] 0.132 † p § 0.035 <0.001 0.120 Mean Arterial Pressure (mmHg) ¶ Pre-anesthetic 98.8 ± 13.7 93.4 ± 11.4 104.3 ± 13.2 0.005 * Immediate post-induction 87.5 ± 11.2 90.8 ± 9.9 93.0 ± 14.6 0.245 * 1 st hour post-induction 83.6 ± 9.3 83.5 ± 7.4 88.3 ± 9.8 0.089 * 2 nd hour post-induction 84.6 ± 12.5 85.2 ± 9.1 90.6 ± 13.4 0.266 * End of case 94.7 ± 11.9 91.2 ± 11.1 94.1 ± 14.6 0.462 * PACU 94.3 ± 12.5 94.3 ± 11.8 97.6 ± 10.1 0.403 * p ‡ <0.001 <0.001 <0.001 Table 2 compares the heart rate and mean arterial pressure (MAP) among the erector spinae plane block (ESPB), quadratus lumborum block (QLB), and control groups in a clinical setting. The heart rate is represented by median values ( ΙΙ ) and mean arterial pressure is shown as mean ± standard deviation ( ¶ ). Statistical tests included one-way analysis of variance (ANOVA) ( * ), the Kruskal–Wallis test ( † ), repeated measures ANOVA ( ‡ ), and the Friedman test ( § ). These tests evaluate differences across the groups at various time points: pre-anesthesia, immediately post-induction, hourly intraoperatively, at the end of the case, in the postanesthesia care unit (PACU). P-values indicate the statistical significance of the differences observed, with values less than 0.05. The table offers a comprehensive view of temporal changes in heart rate, mean arterial pressure among the groups throughout the perioperative period. Table 3. Comparative analysis of resting and movement visual analog scale (VAS) scores among the ESPB, QLB, and control groups. Groups p ESPB (n = 30) QLB (n = 30) Control (n = 30) Resting VAS Score (0-10) ΙΙ Postoperative 2 nd hour 1.0 [0.0 – 3.0] 2.0 [0.0 – 3.0] 2.0 [1.0 – 4.0] <0.001 * Postoperative 6 th hour 1.5 [0.0 – 3.0] 2.0 [0.0 – 3.0] 2.0 [1.0 – 4.0] 0.009 * Postoperative 12 th hour 1.5 [0.0 – 3.0] 2.0 [0.0 – 3.0] 2.0 [1.0 – 3.0] 0.089 * Postoperative 24 th hour 1.0 [0.0 – 3.0] 1.0 [0.0 – 3.0] 2.0 [1.0 – 4.0] 0.002 * p § 0.149 0.677 0.729 Movement VAS Score (0-10) ΙΙ Postoperative 2 nd hour 2.0 [0.0 – 3.0] 2.0 [0.0 – 3.0] 3.0 [1.0 – 4.0] <0.001 * Postoperative 6 th hour 2.0 [1.0 – 3.0] 2.0 [1.0 – 3.0] 3.0 [2.0 – 4.0] <0.001 * Postoperative 12 th hour 3.0 [1.0 – 3.0] 2.5 [1.0 – 3.0] 3.0 [1.0 – 4.0] 0.002 * Postoperative 24 th hour 2.0 [0.0 – 3.0] 2.0 [0.0 – 3.0] 3.0 [1.0 – 4.0] <0.001 * p § 0.013 0.228 0.996 Table 3 compares the resting and movement visual analog scale (VAS) scores among the erector spinae plane block (ESPB), quadratus lumborum block (QLB), and control groups in a clinical setting. VAS scores are represented by median values ( ΙΙ ). Statistical tests included one-way analysis of variance (ANOVA) ( * ) and the Friedman test ( § ). These tests evaluate differences across the groups at various time points: 2 nd , 6 th , 12 th and 24 th hours in the ward postoperatively. P-values indicate the statistical significance of the differences observed, with values less than 0.05. The table offers a comprehensive view of temporal changes in heart rate, mean arterial pressure, and pain perception among the groups throughout the perioperative period, as assessed using VAS scores. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3933636","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":272900341,"identity":"29fbc604-560e-48d5-87a6-89197faf0ae2","order_by":0,"name":"Onur BARAN","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYDCCAwiS8TGYzczcQLQWZmMGBgMgxUi8FjZpsBYGAlr4bh8+9ph3zx158/azx6oLKv5E87cDtfyo2IZTi+S5tHRjnmfPDOecyUu7PeOMQe6Mw4wNjD1nbuPUYnCGx0ya58BhxhkMOWa3edsMchuAWpgZ2whrsZ/B/8asGKRlPrFaEmdI5Jgxg7RsIKRF8gxbmuScA8+SZ0i8MZbmOWOcuxGo5SA+v/CdYT4m8ebAHdsZ/DmGn3kq5HLnnT988MGPCtxasIMDJKofBaNgFIyCUYAGAJRDWXWE4x/NAAAAAElFTkSuQmCC","orcid":"","institution":"Namık Kemal University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Onur","middleName":"","lastName":"BARAN","suffix":""},{"id":272900342,"identity":"beeb9195-8be8-4976-98a5-900c907723dc","order_by":1,"name":"Ayhan ŞAHİN","email":"","orcid":"","institution":"Namık Kemal University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ayhan","middleName":"","lastName":"ŞAHİN","suffix":""}],"badges":[],"createdAt":"2024-02-06 10:59:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3933636/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3933636/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51237395,"identity":"2481890b-0137-444b-aab4-2bd73d1c3de4","added_by":"auto","created_at":"2024-02-16 16:45:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":12376426,"visible":true,"origin":"","legend":"\u003cp\u003eErector spinae plane block. \u003cstrong\u003e(A) \u003c/strong\u003eA high-frequency linear ultrasound probe was placed craniocaudally 2-3 cm lateral to the midline at the T9 vertebra level. Using the in-plane technique, the needle was placed at the tip of the transverse process anterior to the erector spinae plane muscle with a craniocaudal approach. \u003cstrong\u003e(B)\u003c/strong\u003e The deposition of local anesthetic into the plane between the tip of the transverse process and the erector spinae muscle. ESM: erector spinae muscle, LA: local anesthetic, TP: transverse process. The star indicates the tip of the needle. White arrows indicate the needle shaft.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3933636/v1/1ee624eb3b6f707296657ea7.png"},{"id":51237397,"identity":"88bbd72b-abdc-4604-a064-ffc2ef3108cc","added_by":"auto","created_at":"2024-02-16 16:45:49","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":6099147,"visible":true,"origin":"","legend":"\u003cp\u003eQuadratus lumborum block. \u003cstrong\u003e(A) \u003c/strong\u003eThe transverse processes of the L4 vertebra, psoas, quadratus lumborum, and erector spinae muscles were detected with a low-frequency curvilinear probe placed between the iliac crest and the 12th rib at the midaxillary line. \u003cstrong\u003e(B) \u003c/strong\u003eLocal anesthetic spread was observed in the plane between the quadratus lumborum and psoas muscles. ESM: erector spinae muscle, LA: local anesthetic, TP: transverse process. QLM: quadratus lumborum muscle. The star indicates the tip of the needle. White arrows indicate the needle shaft.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3933636/v1/fd60dc7fffb011929fce67af.png"},{"id":51237398,"identity":"f146a37b-5322-431b-9a10-10d28b173edf","added_by":"auto","created_at":"2024-02-16 16:45:49","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":294470,"visible":true,"origin":"","legend":"\u003cp\u003eConsolidated Standards of Reporting Trials (CONSORT) flow diagram. ESPB: erector spinae plane block, QLB: quadratus lumborum block.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-3933636/v1/1221739f23edc36058e92ab7.png"},{"id":51237399,"identity":"2bec063c-1e45-4d1d-b9d7-d54e8f764ccc","added_by":"auto","created_at":"2024-02-16 16:45:49","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1303571,"visible":true,"origin":"","legend":"\u003cp\u003e(\u003cstrong\u003eA\u003c/strong\u003e) illustrates the variation in pulse rate among diverse groups over time, and (\u003cstrong\u003eB\u003c/strong\u003e) depicts the trends in mean arterial pressure within erector spinae plane block (ESPB), quadratus lumborum block (QLB), and control groups over the same period.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-3933636/v1/92b54ff7e51577fc081233dd.png"},{"id":51238755,"identity":"44806527-27b6-4c4f-a9c5-214f6ea87d27","added_by":"auto","created_at":"2024-02-16 16:53:48","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":593288,"visible":true,"origin":"","legend":"\u003cp\u003e(\u003cstrong\u003eA\u003c/strong\u003e) illustrates the variation in resting visual analog scale (VAS) scores among the different groups over time, and (\u003cstrong\u003eB\u003c/strong\u003e) depicts the trends in movement VAS scores within the erector spinae plane block (ESPB), quadratus lumborum block (QLB), and control groups over the same period.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-3933636/v1/5b1d7e43d8b11f8559106323.png"},{"id":56838577,"identity":"f8381b5a-c7fa-4776-9e07-1bff46d28e37","added_by":"auto","created_at":"2024-05-21 06:33:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":26950706,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3933636/v1/e0b3ea53-72a8-42cd-852d-851b0084c398.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative efficacy of erector spinae plane and quadratus lumborum blocks in managing postoperative pain for total abdominal hysterectomy: A randomized controlled trial","fulltext":[{"header":"Background","content":"\u003cp\u003eRegarding frequency of application, cesarean section is the most commonly performed obstetric surgery, followed by hysterectomy[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Total abdominal hysterectomy (TAH) is a serious major surgical procedure that negatively affects postoperative recovery and is associated with severe postoperative pain [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Severe pain after TAH should be treated using a multimodal pain control strategy. Limiting opioid consumption, which has many side effects such as nausea, vomiting, and respiratory depression, and relieving pain by using the least amount of opioids is one of the most important goals of anesthesiologists [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough the quadratus lumborum block (QLB), an abdominal wall block applied under ultrasound guidance, was first defined by Blanco et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] as a variation of the transversus abdominis plane block (TAPB), various application approaches to this block have been defined over time [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. It is performed by applying a local anesthetic to the anterior, posterior, or lateral quadratus lumborum muscle, and the nomenclature is based on the targeted anatomical location [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The anterior QLB is aimed at delivering high-volume local anesthetic to the interfascial plane between the quadratus lumborum muscle and the psoas muscle, and this approach is practical in providing postoperative pain control in many studies [\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSince its description by Forero et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], the erector spinae plane block (ESPB) has proven effective in providing postoperative analgesia and reducing opioid consumption after numerous surgical procedures [\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The main goal of this block is to block the ventral and dorsal branches of the relevant spinal nerves by applying a high volume of local anesthetic between the tip of the transverse process of the relevant vertebra and the erector spinae muscle under ultrasound guidance [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, we hypothesized that the ESPB and QLB could reduce opioid consumption by providing multimodal analgesia after TAH. In this context, the primary outcome was the 24-hour cumulative opioid consumption in the ESPB, QLB, and control groups, and the secondary outcomes were the postoperative visual analog scale (VAS) score, postoperative first rescue analgesic time, and the presence of nausea and vomiting.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis prospective, double-blind, randomized controlled study was conducted in accordance with\u0026nbsp;the principles of the Declaration of Helsinki. The study protocol, approved by the Tekirdağ Namık Kemal University Ethics Committee, is registered with\u0026nbsp;ClinicalTrials.gov on 09/01/2023 (NCT05675657). Written\u0026nbsp;informed consent was obtained from all patients before their inclusion in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients who were scheduled to undergo elective TAH under general anesthesia by the Department of Gynecology and Obstetrics at Tekirdağ Namık Kemal University Hospital, Tekirdağ, Turkey between January 15, 2023, and July 15, 2023, were included in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients aged 18\u0026ndash;75\u0026nbsp;years with American Society of Anesthesiologists (ASA) physical scores of I and II were included in the study. Patients who met the following exclusion criteria were excluded from the study:\u0026nbsp;patients who did not agree to participate in the study, those with body mass index (BMI) \u0026gt; 35 kg/m\u003csup\u003e2\u003c/sup\u003e, patients younger than 18 years of age, patients older than 75 years of age, patients with uncontrolled systemic disease, those with whom cooperation could not be ensured, such as mental retardation, patients with low cardiac capacity, patients with a history of allergy to planned and possible drugs, coagulopathy, local infection, or addiction to opioids.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe patients were randomized into three groups using the sealed envelope method through a computer-based program (https://www.randomizer.org), with equal\u0026nbsp;numbers of patients in each group.\u0026nbsp;Researchers who applied\u0026nbsp;the blocks to the patients and those who administered anesthesia and followed the patients during the postoperative period differed.\u0026nbsp;Therefore, researchers other than those who applied\u0026nbsp;the blocks to\u0026nbsp;patients did not know which group the patients belonged to. The blinding was achieved in this manner.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll patients underwent surgery under general anesthesia. Before general anesthesia,\u0026nbsp;the patients were evaluated in the pre-anesthesia room according to the group to which they were randomized. According to the sealed envelope system, the patient was taken directly to the operating room\u0026nbsp;and preparations for general anesthesia were initiated if the patient was in the control group. If the patient was in the ESPB or QLB group, they were placed in the area reserved for peripheral nerve blocks.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients underwent 3-channel electrocardiogram (ECG), noninvasive blood pressure, and peripheral oxygen saturation monitoring in a particular area reserved for peripheral nerve block. A total of 0.02 mg.kg\u003csup\u003e-1\u003c/sup\u003e intravenous (iv) midazolam was administered along with saline infusion sufficient to ensure patency of the intravenous vascular access. An ultrasound machine (Esaote, MyLab Six, Genova, Italy) with linear and curved probes was installed and used for\u0026nbsp;the block groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll patients underwent surgery under general anesthesia. From the moment the patient entered the operating room, 3-way ECG, noninvasive blood pressure, and peripheral oxygen saturation monitoring were performed. Following the induction with 2.5 mg.kg\u003csup\u003e-1\u003c/sup\u003e propofol, one mcg.kg\u003csup\u003e-1\u003c/sup\u003e fentanyl, and 0.5 mg.kg\u003csup\u003e-1\u003c/sup\u003e rocuronium, the patients were successfully intubated, and anesthesia was maintained with sevoflurane and 50% oxygen-air mixture. All patients received\u0026nbsp;a remifentanil infusion\u0026nbsp;titrated to 0.1\u0026ndash;1 mcg.kg.min\u003csup\u003e-1\u003c/sup\u003e. Thirty minutes before the end of the surgery, 1 g of paracetamol and ondansetron were administered. After successful recovery from anesthesia and extubation,\u0026nbsp;the patients were\u0026nbsp;transferred to a postanesthesia care unit (PACU).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA tramadol-based patient controlled analgesia (PCA) device was connected to the patients in the PACU for postoperative analgesia. The PCA device contained 3 mg.ml\u003csup\u003e-1\u003c/sup\u003e tramadol, was set to 3.5 ml bolus, had a 20-minute lockout, and had a 4-hour limit of 35 ml. During the postoperative period, 1 g\u0026nbsp;of paracetamol was administered\u0026nbsp;every 6 h. In cases where the VAS score was four or above, diclofenac 75 mg was ordered, followed by 100 mg tramadol as rescue analgesia when a VAS score of 4 or above was still observed 30 min later. Diclofenac was administered at a maximum dose of 150 mg/day, and tramadol at a maximum of 400 mg/day hours. During this process, the VAS score, number of postoperative nausea and vomiting\u0026nbsp;(PONV) episodes, and first rescue analgesic time were recorded in the PACU and\u0026nbsp;ward at 2, 6, 12, and 24 h by an assistant independent of the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eESPB technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor ESPB, the patient was placed in the prone position. After skin sterilization, a high-frequency linear ultrasound probe was placed perpendicular to the midline at the T9 vertebra level. After the spinous process level was identified on the ultrasound screen, the probe was rotated 90 \u0026deg;clockwise or counterclockwise, such that the identifying light remained on the cranial side and shifted 2\u0026ndash;3 cm laterally from the midline. The paraspinal anatomical structures were identified, and the transverse process and erector spinae muscle were observed posteriorly. A 22-gauge 100 mm sonovisible peripheral nerve block needle was advanced craniocaudally towards the transverse process under ultrasound guidance, keeping the needle tip visible at all times. When the needle tip touched the transverse process, it was slightly withdrawn, and 1\u0026ndash;2 ml of saline was administered for testing (Fig. 1A). If it was observed that the interfascial plane between the erector spinae muscle and the transverse process was separated, 30 ml bupivacaine at 0.25% concentration was given in divided doses and intermittently with negative aspiration, if no blood was observed (Fig. 1B). The same procedure was performed on the contralateral side at the same vertebral level under the same conditions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQLB technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor\u0026nbsp;the QLB, the patient was first placed in a lateral decubitus position with the side chosen for the block on top. By ensuring all\u0026nbsp;aseptic conditions, the transverse processes of the L4 vertebra, psoas muscle, quadratus lumborum, and erector spinae muscles were detected with\u0026nbsp;a low-frequency curvilinear probe placed between the iliac crest and the 12th rib at the midaxillary line (Fig. 2A). Using a 22-gauge 100 mm sonovisible peripheral nerve block needle under ultrasound guidance, keeping the needle tip constantly visible, the quadratus lumborum muscle was passed transmuscularly in the posteroanterior plane, and 1\u0026ndash;2 ml of saline was administered to the interfascial plane between the psoas muscle and the quadratus lumborum muscle, following negative blood aspiration. After the separation in the interfascial plane was observed, 30 ml 0.25% bupivacaine was applied with intermittent aspiration to prevent intravenous injection. Local anesthetic spread was observed between the quadratus lumborum and psoas muscle (Fig. 2B). The same procedure was performed on the contralateral side, under\u0026nbsp;identical conditions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eControl group interventions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the control group, patients were transferred from pre-anesthesia to\u0026nbsp;the operating room\u0026nbsp;without block interventions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome measurements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcome was the 24-hour cumulative opioid consumption in the ESPB, QLB, and control groups. The secondary outcomes were the postoperative visual analog scale score, postoperative first rescue analgesic time, and the presence of nausea and vomiting, recorded in the PACU and ward at 2, 6, 12, and 24 h by an assistant independent of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size calculation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe power analysis for our primary hypothesis, which investigated \u0026quot;the effect of\u0026nbsp;the ESPB\u0026nbsp;and\u0026nbsp;QLB on postoperative opioid consumption in patients undergoing TAH,\u0026quot; was conducted with a focus on the variable of postoperative opioid consumption to determine whether there was a significant effect between different treatment groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOwing to the lack of directly comparable studies in the literature and the inability to conduct a pilot study, the power analysis was based on the assumptions of a medium effect size (Cohen\u0026apos;s d of 0.5),\u0026nbsp;5% risk of Type I error (alpha), and 80% power (1-beta error, Type II error).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe analysis concluded that approximately 14 participants per group (ESPB, QLB, control) were required, making 42 participants sufficient. The sample size was determined to ensure adequate power to test the primary hypotheses. However, our study included 90 participants (30 in each group).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were used to summarize the data. For continuous (numerical) variables, depending on the distribution, either mean \u0026plusmn; standard deviation or median with minimum and maximum values were presented in a tabular format. Categorical variables are summarized as counts and percentages. The normality of\u0026nbsp;the numerical variables was assessed using the Shapiro\u0026ndash;Wilk, Kolmogorov\u0026ndash;Smirnov, and Anderson\u0026ndash;Darling tests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Fisher\u0026ndash;Freeman\u0026ndash;Halton test\u0026nbsp;was used to compare\u0026nbsp;categorical variable differences across groups. Compared to two independent groups, the Mann\u0026ndash;Whitney U test was used for numerical variables that did not follow a normal distribution.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn comparisons involving more than two independent groups, the one-way analysis of variance (ANOVA) test was used for numerical variables that exhibited\u0026nbsp;a normal distribution, while the Kruskal\u0026ndash;Wallis H test was employed for those that did not exhibit\u0026nbsp;a normal distribution. For multiple comparisons in parametric tests, either the Games\u0026ndash;Howell or Tukey\u0026rsquo;s tests\u0026nbsp;were used, whereas for non-parametric tests, the Dwass\u0026ndash;Steel\u0026ndash;Critchlow\u0026ndash;Fligner test was applied.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor within-group comparisons of pulse, mean arterial pressure, resting\u0026nbsp;VAS score, and movement VAS score, the repeated measures ANOVA was used when numerical variables showed a normal distribution, and the Friedman test, a non-parametric version of repeated measures ANOVA, was employed otherwise.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Tukey test was used for parametric test methods, whereas the Durbin\u0026ndash;Conover test was applied for non-parametric methods to identify differences between measurements. This study incorporated the Bonferroni correction to control for the possibility of false positives (Type I error) due to multiple comparisons. The Bonferroni correction was used to reduce the risk of false determination\u0026nbsp;of significance in each of the multiple statistical tests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur study measured two variables across three groups (ESPB, QLB, and control). These measurements were taken at six distinct time points to assess pulse and mean arterial pressure: pre-anesthetic, immediately post-induction, at the 1st-hour post-induction, at the 2nd-hour post-induction, at the end of the case, and in the\u0026nbsp;postanesthesia care unit (PACU). Additionally, measurements were conducted at four different time points in the same three groups for the resting and moving VAS scores.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe performed all possible pairwise comparisons among the three groups at each time point, resulting in three pairwise comparisons at\u0026nbsp;each time point (ESPB-QLB, ESPB-control, and QLB-control). Consequently, with measurements repeated across six\u0026nbsp;time points, the pairwise comparisons totaled 18 for pulse and mean arterial pressure. Similarly, for the resting and moving VAS scores, 12 pairwise comparisons were made, considering three pairwise comparisons across\u0026nbsp;the four\u0026nbsp;time points.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAfter applying\u0026nbsp;Bonferroni correction, the overall significance level of 0.05 was divided by 18 comparisons. Consequently, the new threshold for the significance of each comparison was set to p \u0026lt; 0.0028. A p-value below this threshold indicated statistical significance for the respective comparison.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs mentioned above, the Bonferroni correction and the newly calculated significance threshold of p \u0026lt; 0.0028 were explicitly applied to the results presented in Table 2 and Table 3. These adjustments and thresholds are specific to the multiple time points, and group comparisons in this table and are not applicable to the analysis results in other study sections.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed using Jamovi (version 2.3.28) and JASP (version 0.17.3) software, and a significance level of 0.05 (p-value) was considered for all statistical analyses.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn our study, 103 patients were screened, and 13 were excluded (Fig. 3). 90 participants were analyzed; the mean age was 47.7 \u0026plusmn; 6.1 years. The mean BMI of the participants was 25.6 \u0026plusmn; 3.1. The median block time for the procedure was 480 s. The median operative time was 122 min. Postoperative pain assessed using the PACU VAS, had a median score of 2. The total amount of postoperative opioids administered had a median of 52.5 mg. The median time to first rescue analgesic requirement was 16 h. Regarding\u0026nbsp;PONV, most patients (76.7%, n = 69) did not experience adverse events.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study revealed no significant differences between the groups\u0026nbsp;in\u0026nbsp;terms of BMI, block time, or operative time (p \u0026gt; 0.05). However, a significant age disparity was observed, with patients undergoing the ESPB being significantly older than those receiving the QLB (p = 0.003). Regarding postoperative pain management, both\u0026nbsp;the PACU VAS scores and total postoperative opioid analgesic doses were comparable between the ESPB and QLB\u0026nbsp;groups (p \u0026gt; 0.05). Conversely, these measurements were significantly higher in the control group than in the ESPB and QLB groups (p \u0026lt; 0.05). The time to the first rescue analgesic requirement was significantly shorter in the control group\u0026nbsp;than in the ESPB and QLB groups (p \u0026lt; 0.001 and p = 0.001, respectively). Simultaneously, it was similar between\u0026nbsp;the ESPB and QLB\u0026nbsp;groups (p = 0.978). Lastly, the incidence of PONV was comparable between\u0026nbsp;the ESPB and QLB\u0026nbsp;groups but significantly higher in the control group (p = 0.029) (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur study found no significant differences between\u0026nbsp;the groups\u0026nbsp;in terms of pulse rate and mean arterial pressure at any measurement point (both p \u0026gt; 0.0028). In\u0026nbsp;the measurements of resting VAS scores, significant differences emerged between the groups at the\u0026nbsp;postoperative 2nd and 24th hours (p \u0026lt; 0.001 and p = 0.002, respectively). Specifically,\u0026nbsp;the VAS scores were significantly higher in the control group\u0026nbsp;than in the ESPB group at the postoperative 2nd hour. No significant differences were observed in the other pairwise comparisons. At the postoperative 24th hour, there were no significant differences in\u0026nbsp;the pairwise comparisons between the groups. When analyzing the movement VAS scores, significant differences were observed at all measurement points between the groups (p \u0026lt; 0.0028 for each). Movement VAS scores at the\u0026nbsp;postoperative 2nd, 6th, and 24th hours were notably higher in the control group than in both\u0026nbsp;the ESPB and QLB groups (p \u0026lt; 0.001), while scores were similar between the ESPB and QLB groups (p\u0026nbsp;\u0026gt; 0.05). At the postoperative 6-h mark, no significant differences were found in\u0026nbsp;the pairwise comparisons of the movement VAS scores (each p \u0026gt; 0.028).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the intragroup comparisons within the ESPB group, no significant changes were observed in the pulse rate and resting and movement VAS scores (each p \u0026gt; 0.0028). However, a significant change was observed in the mean arterial pressure over time (p \u0026lt; 0.001). Specifically, the mean arterial pressures at the 1st and 2nd hour post-induction were significantly lower than the baseline values (each p \u0026lt; 0.001). No significant differences were observed in the other pairwise comparisons within the ESPB group (each p \u0026gt; 0.0028). No significant changes in the pulse rate and resting or movement VAS scores were observed in the control group (each p \u0026gt; 0.0028). However, a significant difference was found in mean arterial pressure (p \u0026lt; 0.001), with immediate post-induction mean arterial pressures being significantly lower than the pre-anesthetic values (p \u0026lt; 0.001) (Fig. 4 and Fig. 5) (Table 2 and Table 3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study's primary focus was to evaluate the analgesic efficacy of the ESPB and QLB in patients undergoing TAH, with particular emphasis on postoperative opioid consumption. The results indicated that both ESPB and QLB were effective in reducing postoperative pain and opioid requirements compared with the control group, with no significant difference between the ESPB and QLB groups.\u003c/p\u003e \u003cp\u003eThese findings are consistent with those of recent studies that have explored the effectiveness of ESPB and QLB in various surgical contexts. For instance, Jiang et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] demonstrated that both the ESPB and the transmuscular QLB improved multimodal analgesia quality in total laparoscopic hysterectomy, suggesting their potential to reduce opioid consumption. Similarly, our study found comparable efficacy between ESPB and QLB, reinforcing that both techniques are viable options for postoperative pain management in patients with TAH.\u003c/p\u003e \u003cp\u003eMoreover, the study by Zanfini et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] on postoperative analgesia after cesarean section using ESPB and QLB found no significant difference in total morphine consumption between the two groups, aligning with our findings of comparable opioid consumption between ESPB and QLB groups. These findings further support the idea that both blocks effectively manage postoperative pain during abdominal surgery.\u003c/p\u003e \u003cp\u003eInterestingly, a study on laparoscopic liver resection [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] also reported similar postoperative analgesia between the ESP and QL blocks, which aligns with our findings. This consistency across different types of surgeries suggests a broader applicability of these blocks in various surgical procedures.\u003c/p\u003e \u003cp\u003eFurthermore, a study comparing the ESPB and QLB in open nephrectomy [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] reported similar outcomes in terms of morphine consumption and pain scores, corroborating our findings regarding the efficacy of both blocks.\u003c/p\u003e \u003cp\u003eA study on pediatric postoperative pain management [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] suggested that the QLB might provide more effective analgesia than the ESPB in specific contexts, indicating the need for further research to explore the differential effectiveness of these blocks in various patient populations and surgical procedures.\u003c/p\u003e \u003cp\u003eIn terms of the adjuvants used in ESPB, a study [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] highlighted the efficacy of dexmedetomidine over dexamethasone in enhancing the analgesic profile of ESPB. This finding suggests potential avenues for optimizing ESPB techniques, which could be relevant to future studies on TAH.\u003c/p\u003e \u003cp\u003eFinally, a comparison between the QLB and TAPB [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] in patients with TAH showed that the QLB was more effective, reinforcing our study's findings regarding the efficacy of the QLB in managing postoperative pain in TAH.\u003c/p\u003e \u003cp\u003eThis study had some certain limitations. Even though the study was conducted prospectively and randomly, the patients were awake even under sedation during the block procedures. Although they did not know which block was performed, the patients may not be considered fully blinded. This situation was tried to be eliminated by ensuring that the people who followed the patients in the postoperative period did not know whether any blocks were applied to the patients.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur study contributes significantly to the evidence supporting the ESPB and QLB as effective postoperative pain management strategies for patients with TAH. These findings align with existing literature, suggesting that both ESPB and QLB are viable options for reducing opioid consumption and managing postoperative pain during abdominal surgery. Future studies should explore the differential effects of these blocks on various patient demographics, surgical procedures, and the use of different adjuvants to optimize their analgesic efficacy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eTAH:\u003c/strong\u003e Total abdominal hysterectomy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQLB:\u003c/strong\u003e Quadratus lumborum block\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTAPB:\u003c/strong\u003e Transversus abdominis plane block\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eESPB:\u003c/strong\u003e Erector spinae plane block\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVAS:\u003c/strong\u003e Visual analog scale\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eASA:\u003c/strong\u003e American society of anesthesiologists\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBMI:\u003c/strong\u003e Body mass index\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eECG:\u003c/strong\u003e Electrocardiogram\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePACU:\u003c/strong\u003e Postanesthesia care unit\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePCA:\u003c/strong\u003e Patient controlled analgesia\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePONV:\u0026nbsp;\u003c/strong\u003ePostoperative nausea and vomiting\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis prospective, double-blind, randomized controlled study was conducted in accordance with\u0026nbsp;the principles of the Declaration of Helsinki. The study protocol, approved by the Tekirdağ Namık Kemal University Ethics Committee (2022.206.11.07), is registered with\u0026nbsp;ClinicalTrials.gov (NCT05675657).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten\u0026nbsp;informed consent was obtained from all patients before their inclusion in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOB and AŞ designed the study, performed blocks, followed the patients, analyzed the data and wrote the main manuscript text including tables and figures. All the authors reviewed the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI very much appreciate Prof. Dr. Cavidan Arar who played a decisive role in this study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKamel AAF, Amin OAI, Ibrahem MAM. Bilateral Ultrasound-Guided Erector Spinae Plane Block Versus Transversus Abdominis Plane Block on Postoperative Analgesia after Total Abdominal Hysterectomy. Pain Physician. 2020;23(4):375\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShukla U, Yadav U, Singh AK, Tyagi A. Randomized Comparative Study Between Bilateral Erector Spinae Plane Block and Transversus Abdominis Plane Block Under Ultrasound Guidance for Postoperative Analgesia After Total Abdominal Hysterectomy. Cureus. 2022;14(5):e25227.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShukla U, Yadav U, Duggal J. A Comparative Study of Ultrasound-Guided Quadratus Lumborum Block and Transversus Abdominis Plane Block for Postoperative Analgesia Following Total Abdominal Hysterectomy. Cureus. 2023;15(3):e36412.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaaz S, Kumar R, Ozair E, Sahay N, Asghar A, Jha S, Akhil VP. Ultrasound Guided Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Post-operative Analgesia in Patients Undergoing Total Abdominal Hysterectomy. Turk J Anaesthesiol Reanim. 2021;49(5):357\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOmara AF, Elbadry AA, Abo Hagar AM. Quadratus Lumborum Block Against Coupled Transversus Abdominis Block and Ilioinguinal/Iliohypogastric Nerve Blocks for Postoperative Analgesia After Total Abdominal Hysterectomy: A Randomized Controlled Trial. Anesth Pain Med. 2023;13(2):e134845.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e271. Tap block under ultrasound guidance: the description of a no pops technique. \u003cem\u003eRegional Anesthesia \u0026amp; Pain Medicine\u003c/em\u003e 2007, 32(Suppl 1):130.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlanco R, Ansari T, Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: A randomised controlled trial. Eur J Anaesthesiol. 2015;32(11):812\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eB\u0026oslash;rglum J, Moriggl B, Jensen K, L\u0026oslash;nnqvist P-A, Christensen AF, Sauter A, Bendtsen TF. Ultrasound-guided transmuscular quadratus lumborum blockade. BJA: Br J Anaesth 2013, 111(eLetters Supplement).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Boghdadly K, Elsharkawy H, Short A, Chin KJ. Quadratus Lumborum Block Nomenclature and Anatomical Considerations. Reg Anesth Pain Med. 2016;41(4):548\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao WL, Li SD, Wu B, Zhou ZF. Quadratus Lumborum Block is an Effective Postoperative Analgesic Technique in Pediatric Patients Undergoing Lower Abdominal Surgery: A Meta-Analysis. Pain Physician. 2021;24(5):E555\u0026ndash;e563.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiong H, Chen X, Zhu W, Yang W, Wang F. Postoperative analgesic effectiveness of quadratus lumborum block: systematic review and meta-analysis for adult patients undergoing hip surgery. J Orthop Surg Res. 2022;17(1):282.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUppal V, Retter S, Kehoe E, McKeen DM. Quadratus lumborum block for postoperative analgesia: a systematic review and meta-analysis. Can J Anesthesia/Journal canadien d'anesth\u0026eacute;sie. 2020;67(11):1557\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016;41(5):621\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoo CH, Lee HT, Na HS, Ryu JH, Shin HJ. Efficacy of Erector Spinae Plane Block for Analgesia in Thoracic Surgery: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth. 2022;36(5):1387\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiang X, Zhou W, Fan Y. Erector spinae plane block for spinal surgery: a systematic review and meta-analysis. Korean J Pain. 2021;34(4):487\u0026ndash;500.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStatistically significant but clinically unimportant: a systematic review and meta-analysis of the analgesic benefits of erector spinae plane block following breast cancer surgery. \u003cem\u003eRegional Anesthesia \u0026amp; Pain Medicine\u003c/em\u003e 2021, 46(1):3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eViderman D, Aubakirova M, Abdildin YG. Erector Spinae Plane Block in Abdominal Surgery: A Meta-Analysis. Front Med 2022, 9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKot P, Rodriguez P, Granell M, Cano B, Rovira L, Morales J, Broseta A, Andr\u0026eacute;s J. The erector spinae plane block: a narrative review. Korean J Anesthesiol. 2019;72(3):209\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang W, Wang M, Wang X, Jin S, Zhang M, Zhang L, Zhang Y, Wu Y. Effects of Erector Spinae Plane Block and Transmuscular Quadratus Lumborum Block on Postoperative Opioid Consumption in Total Laparoscopic Hysterectomy: A Randomized Controlled Clinical Trial. Pain Ther 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZanfini BA, Di Muro M, Biancone M, Catarci S, Piersanti A, Frassanito L, Ciancia M, Toni F, Santantonio MT, Draisci G. Ultrasound-Guided Bilateral Erector Spinae Plane Block vs. Ultrasound-Guided Bilateral Posterior Quadratus Lumborum Block for Postoperative Analgesia after Caesarean Section: An Observational Closed Mixed Cohort Study. J Clin Med. 2023;12(24):7720.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKang R, Lee S, Kim GS, Jeong JS, Gwak MS, Kim JM, Choi GS, Cho YJ, Ko JS. Comparison of Analgesic Efficacy of Erector Spinae Plane Block and Posterior Quadratus Lumborum Block in Laparoscopic Liver Resection: A Randomized Controlled Trial. J Pain Res. 2021;14:3791\u0026ndash;800.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOnay M, Erdoğan Kayhan G, \u0026Ouml;zen A, Şanal Baş S, Yelken B. Comparison of ultrasound-guided quadratus lumborum block and erector spinae plane block in terms of their effects on postoperative pain in open nephrectomy. Minerva Anestesiol. 2023;89(1\u0026ndash;2):32\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaman HI, LahloUb FM, Farid AM, Hegazy MA, Elshahawy ME, Elawady MS. Bilateral erector spinae plane block vs quadratus lumborum block for postoperative pain management after pediatric laparoscopic abdominal surgery: a randomized comparative study. Anaesth Pain Intensive Care. 2022;26(5):602\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohammed Ali DS, Salama AM, Abaza KA, Ahmed FM. Dexamethasone versus Dexmedetomidine as Adjuvant to Bupivacaine in Ultrasound Guided Erector Spinae Plane Block for Analgesia in Total Abdominal Hysterectomy. Egypt J Hosp Med. 2022;88(1):4051\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlansary AM, Kamaly AM, Abdel Hamid HS, Aboelanean YM, Ezzat AW. Ultrasound-guided quadratus lumborum block versus transversus abdominis plane block in patients undergoing total abdominal hysterectomy. Ain-Shams J Anesthesiology. 2022;14(1):22.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e. Comparison of demographic and clinical characteristics among ESPB, QLB, and control Groups in a surgical patient population.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall (n = 90)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.61643835616438%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.91780821917808%\"\u003e\n \u003cp\u003e\u003cstrong\u003eESPB (n = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.91780821917808%\"\u003e\n \u003cp\u003e\u003cstrong\u003eQLB (n = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.54794520547945%\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl (n = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.083333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (yr) \u003csup\u003e\u0026Iota;\u0026Iota;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e47.7 \u0026plusmn; 6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e49.9 \u0026plusmn; 6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e45.2 \u0026plusmn; 3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e48.1 \u0026plusmn; 6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.083333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e) \u003csup\u003e\u0026Iota;\u0026Iota;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e25.6 \u0026plusmn; 3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e25.9 \u0026plusmn; 3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e25.8 \u0026plusmn; 2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e25.1 \u0026plusmn; 3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\"\u003e\n \u003cp\u003e0.583\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.083333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlock Time (s) \u003csup\u003e\u0026para;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e480.0 [147.0 \u0026ndash; 900.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e480.0 [147.0 \u0026ndash; 600.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e488.5 [300.0 \u0026ndash; 900.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\"\u003e\n \u003cp\u003e0.212\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.083333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperation Time (min) \u003csup\u003e\u0026para;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e122.0 [60.0 \u0026ndash; 300.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e134.5 [70.0 \u0026ndash; 220.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e132.5 [85.0 \u0026ndash; 200.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e120.0 [60.0 \u0026ndash; 300.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\"\u003e\n \u003cp\u003e0.530\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.083333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePACU VAS Score \u003csup\u003e\u0026para;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e2.0 [0.0 \u0026ndash; 4.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e1.0 [0.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e1.0 [0.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e2.0 [1.0 \u0026ndash; 4.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.083333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative Total Opioid (mg) \u003csup\u003e\u0026para;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e52.5 [10.5 \u0026ndash; 105.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e42.0 [21.0 \u0026ndash; 63.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e52.5 [10.5 \u0026ndash; 63.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e63.0 [31.5 \u0026ndash; 105.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.083333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst Rescue Analgesic Need Hour (h) \u003csup\u003e\u0026para;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e16.0 [1.0 \u0026ndash; 23.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e19.0 [13.0 \u0026ndash; 23.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e19.0 [13.0 \u0026ndash; 23.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e4.5 [1.0 \u0026ndash; 11.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.083333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of PONV \u003csup\u003e\u0026para;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e0.0 [0.0 \u0026ndash; 1.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e0.0 [0.0 \u0026ndash; 1.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e0.0 [0.0 \u0026ndash; 1.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e0.0 [0.0 \u0026ndash; 1.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.030\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.083333333333332%\" valign=\"top\"\u003e\n \u003cp\u003eNo \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e69 (76.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e26 (86.7)\u0026nbsp;\u003csup\u003e\u0026dagger;\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e25 (83.3)\u0026nbsp;\u003csup\u003e\u0026dagger;\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e18 (60.0)\u0026nbsp;\u003csup\u003e\u0026Dagger;\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.213483146067414%\" valign=\"top\"\u003e\n \u003cp\u003eYes \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.97752808988764%\"\u003e\n \u003cp\u003e21 (23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.97752808988764%\"\u003e\n \u003cp\u003e4 (13.3)\u0026nbsp;\u003csup\u003e\u0026dagger;\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.97752808988764%\"\u003e\n \u003cp\u003e5 (16.7)\u0026nbsp;\u003csup\u003e\u0026dagger;\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.853932584269664%\"\u003e\n \u003cp\u003e12 (40.0)\u0026nbsp;\u003csup\u003e\u0026Dagger;\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 1 compares the demographic and clinical characteristics among erector spinae plane block (ESPB), quadratus lumborum block (QLB), and control groups in a surgical patient population. The\u0026nbsp;\u003csup\u003e\u0026Iota;\u0026Iota;\u003c/sup\u003e symbol represents mean \u0026plusmn; standard deviation, and the \u003csup\u003e\u0026para;\u003c/sup\u003e symbol indicates median values with ranges [minimum-maximum]. Statistical analyses included one-way analysis of variance (ANOVA) (\u003csup\u003e*\u003c/sup\u003e), Mann\u0026ndash;Whitney U test (\u003csup\u003e\u0026dagger;\u003c/sup\u003e)\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003eKruskal\u0026ndash;Wallis test (\u003csup\u003e\u0026Dagger;\u003c/sup\u003e), and Fisher\u0026ndash;Freeman\u0026ndash;Halton test (\u003csup\u003e\u0026sect;\u003c/sup\u003e) to evaluate differences across\u0026nbsp;the ESPB, QLB, and control groups. The\u0026nbsp;\u003csup\u003e**\u003c/sup\u003e symbol denotes the number and percentage of patients (n [%]). In the table,\u0026nbsp;\u0026apos;\u003csup\u003e\u0026dagger;\u0026dagger;\u003c/sup\u003e\u0026apos; and \u0026apos;\u003csup\u003e\u0026Dagger;\u0026Dagger;\u003c/sup\u003e\u0026apos; indicate significant group differences identified in multiple comparison tests, providing insights into variations in factors such as age, body mass index (BMI), block time, operation duration, postanesthesia care unit\u0026nbsp;(PACU) visual analog scale (VAS) score, total postoperative opioid consumption, time first to rescue analgesic requirement, and number of postoperative nausea and vomiting (PONV) episodes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Comparative heart rate and mean arterial pressure analysis among the ESPB, QLB, and control groups.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.57575757575758%\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.666666666666664%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003eESPB (n = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003eQLB (n = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl (n = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePulse (bpm) \u003csup\u003e\u0026Iota;\u0026Iota;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePre-anesthetic\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e80.5 [56.0 \u0026ndash; 109.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e88.5 [66.0 \u0026ndash; 121.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e79.0 [50.0 \u0026ndash; 110.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.007\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eImmediate post-induction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e78.0 [55.0 \u0026ndash; 109.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e87.5 [70.0 \u0026ndash; 116.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e84.0 [56.0 \u0026ndash; 124.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.003\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003csup\u003est\u003c/sup\u003e hour post-induction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e75.0 [50.0 \u0026ndash; 95.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e81.5 [61.0 \u0026ndash; 94.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e72.5 [57.0 \u0026ndash; 104.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.061\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003csup\u003end\u003c/sup\u003e hour post-induction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e76.5 [54.0 \u0026ndash; 96.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e80.5 [63.0 \u0026ndash; 95.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e75.0 [62.0 \u0026ndash; 99.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.281\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eEnd of case\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e81.0 [60.0 \u0026ndash; 96.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e76.5 [61.0 \u0026ndash; 92.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e75.0 [62.0 \u0026ndash; 116.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.970\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePACU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e76.5 [59.0 \u0026ndash; 99.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e74.0 [63.0 \u0026ndash; 95.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e69.5 [50.0 \u0026ndash; 99.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.132\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ep\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Arterial Pressure (mmHg) \u003csup\u003e\u0026para;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePre-anesthetic\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e98.8 \u0026plusmn; 13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e93.4 \u0026plusmn; 11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e104.3 \u0026plusmn; 13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.005\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eImmediate post-induction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e87.5 \u0026plusmn; 11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e90.8 \u0026plusmn; 9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e93.0 \u0026plusmn; 14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.245\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003csup\u003est\u003c/sup\u003e hour post-induction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e83.6 \u0026plusmn; 9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e83.5 \u0026plusmn; 7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e88.3 \u0026plusmn; 9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.089\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003csup\u003end\u003c/sup\u003e hour post-induction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e84.6 \u0026plusmn; 12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e85.2 \u0026plusmn; 9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e90.6 \u0026plusmn; 13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.266\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eEnd of case\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e94.7 \u0026plusmn; 11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e91.2 \u0026plusmn; 11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e94.1 \u0026plusmn; 14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.462\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePACU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e94.3 \u0026plusmn; 12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e94.3 \u0026plusmn; 11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e97.6 \u0026plusmn; 10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.403\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ep\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 compares the heart rate and mean arterial pressure (MAP) among the erector spinae plane block (ESPB), quadratus lumborum block (QLB), and control groups in a clinical setting.\u0026nbsp;The heart rate is represented by median values (\u003csup\u003e\u0026Iota;\u0026Iota;\u003c/sup\u003e) and mean arterial pressure is shown as mean \u0026plusmn; standard deviation (\u003csup\u003e\u0026para;\u003c/sup\u003e). Statistical tests\u0026nbsp;included one-way analysis of variance (ANOVA) (\u003csup\u003e*\u003c/sup\u003e), the Kruskal\u0026ndash;Wallis test (\u003csup\u003e\u0026dagger;\u003c/sup\u003e), repeated measures ANOVA (\u003csup\u003e\u0026Dagger;\u003c/sup\u003e), and the Friedman test (\u003csup\u003e\u0026sect;\u003c/sup\u003e). These tests evaluate differences across the groups at various time points: pre-anesthesia, immediately\u0026nbsp;post-induction, hourly intraoperatively, at the end of the case, in the postanesthesia care unit\u0026nbsp;(PACU). P-values indicate the statistical significance of the differences observed, with values less than 0.05. The table offers a comprehensive view of temporal changes in heart rate, mean arterial pressure among the groups throughout the perioperative period.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Comparative analysis of resting and movement visual analog scale (VAS) scores among the ESPB, QLB, and control groups.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.57575757575758%\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.666666666666664%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003eESPB (n = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003eQLB (n = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl (n = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eResting VAS Score (0-10) \u003csup\u003e\u0026Iota;\u0026Iota;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative 2\u003csup\u003end\u003c/sup\u003e hour\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e1.0 [0.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e2.0 [0.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e2.0 [1.0 \u0026ndash; 4.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative 6\u003csup\u003eth\u003c/sup\u003e hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e1.5 [0.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e2.0 [0.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e2.0 [1.0 \u0026ndash; 4.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.009\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative 12\u003csup\u003eth\u003c/sup\u003e hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e1.5 [0.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e2.0 [0.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e2.0 [1.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e0.089\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative 24\u003csup\u003eth\u003c/sup\u003e hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e1.0 [0.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e1.0 [0.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e2.0 [1.0 \u0026ndash; 4.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ep\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e0.677\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e0.729\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMovement VAS Score (0-10) \u003csup\u003e\u0026Iota;\u0026Iota;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative 2\u003csup\u003end\u003c/sup\u003e hour\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e2.0 [0.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e2.0 [0.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e3.0 [1.0 \u0026ndash; 4.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative 6\u003csup\u003eth\u003c/sup\u003e hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e2.0 [1.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e2.0 [1.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e3.0 [2.0 \u0026ndash; 4.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative 12\u003csup\u003eth\u003c/sup\u003e hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e3.0 [1.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e2.5 [1.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e3.0 [1.0 \u0026ndash; 4.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative 24\u003csup\u003eth\u003c/sup\u003e hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e2.0 [0.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e2.0 [0.0 \u0026ndash; 3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e3.0 [1.0 \u0026ndash; 4.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003ep\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.19191919191919%\"\u003e\n \u003cp\u003e0.996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3 compares\u0026nbsp;the resting and movement\u0026nbsp;visual analog scale (VAS) scores among\u0026nbsp;the erector spinae plane block (ESPB),\u0026nbsp;quadratus lumborum block (QLB), and control groups in a clinical setting. VAS scores are represented by median values (\u003csup\u003e\u0026Iota;\u0026Iota;\u003c/sup\u003e). Statistical tests\u0026nbsp;included one-way analysis of variance (ANOVA) (\u003csup\u003e*\u003c/sup\u003e)\u0026nbsp;and the Friedman test (\u003csup\u003e\u0026sect;\u003c/sup\u003e). These tests evaluate differences across the groups at various time points: 2\u003csup\u003end\u003c/sup\u003e, 6\u003csup\u003eth\u003c/sup\u003e, 12\u003csup\u003eth\u003c/sup\u003e and 24\u003csup\u003eth\u003c/sup\u003e hours in the ward postoperatively. P-values indicate the statistical significance of the differences observed, with values less than 0.05. The table offers a comprehensive view of temporal changes in heart rate, mean arterial pressure, and pain perception among the groups throughout the perioperative period, as assessed using VAS scores.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anesthesia, Erector spinae plane block, Quadratus lumborum block, Total abdominal hysterectomy, Postoperative pain, Opioid consumption","lastPublishedDoi":"10.21203/rs.3.rs-3933636/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3933636/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Effective postoperative pain management after total abdominal hysterectomy is crucial for patient recovery and satisfaction. This study compared the efficacy of the erector spinae plane block and quadratus lumborum block in reducing postoperative opioid consumption and pain in patients with total abdominal hysterectomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e In this prospective, randomized controlled trial, 90 patients undergoing total abdominal hysterectomy were divided into three groups: ESPB, QLB, and control. The primary outcome was postoperative opioid consumption. Secondary outcomes included pain scores assessed by the visual analog scale at predetermined times and the incidence of postoperative nausea and vomiting. Statistical significance was determined using analysis of variance, the Mann–Whitney U test, and the Kruskal–Wallis test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The ESPB and QLB groups showed a significant reduction in postoperative opioid consumption compared with the control group (p \u0026lt; 0.001 for both comparisons). Pain scores were significantly lower in the ESPB and QLB groups than in the control group at 2, 6, and 24 h postoperatively (p \u0026lt; 0.001 at each time point). The incidence of postoperative nausea and vomiting was lower in the ESPB and QLB groups than that in the control group; however, this difference was not statistically significant (p = 0.029). No significant differences were observed in opioid consumption or pain scores between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Both the erector spinae plane and quadratus lumborum blocks effectively reduced postoperative opioid consumption and pain in patientswith total abdominal hysterectomy. These techniques offer a promising approach for postoperative pain management, potentially reducing the need for opioids.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIRB Number: \u003c/strong\u003e2022.206.11.07\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Registry Number: \u003c/strong\u003eNCT05675657\u003c/p\u003e","manuscriptTitle":"Comparative efficacy of erector spinae plane and quadratus lumborum blocks in managing postoperative pain for total abdominal hysterectomy: A randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-16 16:45:41","doi":"10.21203/rs.3.rs-3933636/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"be6b4a59-2489-4167-8f7b-5e29975915e6","owner":[],"postedDate":"February 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-21T06:24:52+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-16 16:45:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3933636","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3933636","identity":"rs-3933636","version":["v1"]},"buildId":"CiT4i_kKBbxQbnFL0ufpk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}