Comparison of the analgesic efficacy of transversus abdominis plane block and posterior approach quadratus lumborum block after open radical retropubic prostatectomy: a randomized controlled trial

Comparison of the analgesic efficacy of transversus abdominis plane block and posterior approach quadratus lumborum block after open radical retropubic prostatectomy: 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 Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of the analgesic efficacy of transversus abdominis plane block and posterior approach quadratus lumborum block after open radical retropubic prostatectomy: a randomized controlled trial Eylem Yasar, Basak Altiparmak, Ahmet Pinarbasi, Ilker Akarken, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3890353/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 Backgroundː Open radical prostatectomy has been found to be related to moderate pain in the early postoperative period. However, postoperative pain, which is not controlled by surgery, can prolong the length of hospital stay. The transversus abdominis plane block technique has been shown to be a safe and effective postoperative analgesic method for urological surgeries. Moreover, it has been reported that a posterior approach involving a Quadratus lumborum block can extend more easily into the thoracic paravertebral space or thoracolumbar plane and provide analgesia from T7 to L1. Methodsː A total of 62 patients with a mean age of 63.2 ± 4 years and a mean body mass index of 24.0 ± 1.6 kg/m² were included in our study. After surgery, the patients were divided into two groups: the first group (Transversus Abdominis Plane) and the second group (Quadratus Lumborum Block) before anaesthesia was terminated. Resultsː The time to postoperative analgesic need, opioid use, opioid dose, and patient satisfaction score were similar for the TAP and QLB block groups. A total of eighteen (29%) patients in both groups needed opioids, for a mean dose of 100 mg. Conclusionsː In conclusion, there was a significant relationship between the opioid dose and the two groups. prostate cancer open prostatectomy transversus abdominis plane block quadratus lumborum block Figures Figure 1 WHAT IS KNOWN To compare the analgesic efficacy and opioid consumption of the two groups within 24 hours postoperatively: first point. Duration of sensory block, opioid-related side effects (postoperative nausea and vomiting, itching, sedation), patient satisfaction and complications related to the block: second point. WHAT IS NEW We hope to contribute to the literature on peripheral nerve blocks used for effective analgesia in open retropubic prostatectomy operations: the third point. INTRODUCTION Prostate cancer is the second most common type of cancer in males worldwide according to 2020 data, and surgery is a commonly preferred method for treating prostate cancer [ 1 ]. Although robotic radical prostatectomy has gained popularity in recent years due to technological developments, open retropubic radical prostatectomy is still a common treatment method for locally advanced prostate cancer [ 2 ]. Open radical prostatectomy has been found to be related to moderate pain in the early postoperative period [ 3 , 4 ]. However, postoperative pain, which is not controlled by surgery, can prolong the length of hospital stay [ 5 ]. The procedure-specific postoperative pain management [PROSPECT] published by Lemoine et al. [ 6 ] suggested that regional techniques such as wound infiltration and transversus abdominis plane [TAP] block are also recommended as a part of multimodal analgesia in addition to pharmacological methods such as paracetamol, nonsteroidal anti-inflammatory drugs and systemic lidocaine infusion following radical prostatectomy. Transversus abdominis plane block is an effective regional analgesia technique. In this method, the sensory afferents of the anterior abdominal wall are blocked at the level of the seventh thoracic and first lumbar vertebra. TAP blocks can be effectively used in various abdominal surgical procedures, such as colorectal surgery, inguinal and umbilical hernia repair, cesarean section, and radical prostatectomy [ 7 – 11 ]. In 2007, the quadratus lumborum block [QLB] was defined by Blanco as a variant of the TAP block [ 12 ]. The blocks, which were previously named QLB-1, QLB-2 and QLB-3 based on the anatomical region of the local anaesthetic injection, were first known as the anterior, lateral, and posterior QLB, respectively, after the Delphy consensus on abdominal wall blocks was published in 2021 [ 13 ]. The posterior QLB is the block created by injecting between the erector spinae muscle and quadratus lumborum muscle [posterior to the quadratus lumborum muscle]. The local anaesthetic agent has been reported to produce analgesia from thoracic 7 to lumbar 1 by extending into the thoracic paravertebral space or thoracolumbar plane [ 14 ]. QLB is used as a part of multimodal analgesia for managing postoperative analgesia in both adults and pediatric patients during abdominal surgeries, such as cesarean section, renal surgery and inguinal hernia repair [ 15 ]. Although studies have focused on the use of anterior QLB following open radical prostatectomy, the number of studies conducted on the effect of posterior QLB is limited [ 22 ]. The aim of this study was to compare the effects of TAP block performed as a part of multimodal analgesia and posterior QLB on postoperative opioid consumption, time to analgesic requirement, patient pain, and satisfaction scores after open radical prostatectomy. Based on our hypothesis, posterior QLB block via ultrasonography after open radical prostatectomy will reduce opioid consumption within 24 hours after surgery compared to TAP block. MATERIALS AND METHODS This was a randomized and double-blinded controlled trial with two parallel arms. The study was conducted at Mugla Training and Research Hospital. The study protocol was approved by the Clinical Trials Ethics Committee of Mugla Sıtkı Kocman University [date 27/10/2021, no 22/III] and registered in the clinical trials.gov [Id: NCT06075498- Trial registration:10/10/2023 ] in October. Written informed consent was obtained from all participants. This study adhered to the 2010 Consolidated Standards of Reporting Trials [CONSORT] guidelines. ASA [American Society of Anaesthesiology classification] I-II-III patients who underwent open prostatectomy surgery under general anaesthesia were included in the study. The ages of the patients were between 18 and 70 years. Patients who refused to participate in the study, were ASA IV, had allergies to study drugs, had any contraindication for regional technique, had coagulation disorders or injection site infections, had chronic analgesic use, could not adapt to the numerical assessment scale [NRS score] or had a body mass index [BMI] above 35 kg/m 2 were excluded from the study. After the patients were taken to the operating room, standard monitoring [electrocardiography, noninvasive blood pressure measurements, and peripheral oxygen saturation] were conducted, and peripheral intravenous access was administered. Standard anaesthesia management was performed with 1.5-3 mg/kg propofol, 1–2 mcg/kg fentanyl and 0.6 mg/kg rocuronium bromide based on the needs of the patients. Heart rate, ECG, noninvasive blood pressure, peripheral oxygen saturation, capnography and bispectral index [BIS] were preoperatively monitored every 15 minutes. For anaesthesia maintenance, 1 MAC desflurane, 0.4/0.6 oxygen air mixture and 0.1–0.2 mcg/kg/min remifentanil infusion were applied to sustain the bispectral index between 45 and 60. Half an hour before terminating the operation, 50 mg of dexketoprofen, 1 mg/kg tramadol for analgesic purposes and 0.1 mg/kg ondansetron for antiemetic purposes were intravenously administered to all patients. Following the surgery, the patients were randomly divided into 2 groups before terminating anaesthesia. After the location of the block was prepared with chlorhexidine in the patients in the first group [of the TAP group], a 5–13 MHz linear probe (SonoSite MTurbo; Fujifilm SonoSite, Bothell, WA) was placed parallel to the anterior axillary line on the iliac crest. Afterwards, a 22-gauge block needle was used to move the needle from anterior to posterior via the in-plane method. After a minimal resistance loss was observed upon entering the facial plane between the external and internal oblique muscle layers, 1–2 mL of saline was injected, and the needle was confirmed to be in the interfacial area. A total of 0.375% mg of bupivacaine was injected into the patients. The same procedure was also applied to the other group. In the second group, [the QLB group], after the skin was sterilized, the convex ultrasound probe was placed perpendicular to the spine in the 12th vertebral body and then advanced laterally to visualize the quadratus lumborum muscle and psoas muscle. By using the in-plane method, a 22-gauge needle was injected between the quadratus lumborum muscle and anterior layer of the thoracolumbar fascia with 1–2 mL of saline and 20 mL of 0.375% mg of bupivacaine. The same procedure was also repeated for the other group. Following the blocking procedure, the volatile agent treatment was terminated in both groups. After recurrence, the patients were extubated and taken to the postoperative recovery unit. A research assistant blinded to the group distribution evaluated the pain level of the patients at the 1st, 2nd, 6th, 12th and 24th postoperative hours by using the numeric rating scale (NRS). For patients whose NRS score was above 5 for half an hour, 100 mg of tramadol was administered. The use of tramadol, which is a nonsteroidal anti-inflammatory medication, was followed for 24 hours. Moreover, complications such as local anaesthesia toxicity, allergies, internal organ injury, postoperative bleeding and postoperative nausea and vomiting were recorded. Patients were evaluated for their satisfaction with the anaesthesia method during the postoperative period as follows: [1, quite unsatisfied; 10, highly satisfied]. The sample size of the study was calculated by using the G*Power program [v3.1.9]. The sample size was estimated based on the 24-hour tramadol dose needed for patients who underwent open prostatectomy surgery. A previous study revealed that there was a 20% decrease in 24-hour tramadol use between two groups of patients, according to the sample size [ 9 ]. Accordingly, when the α error = 0.05 and the power are 80%, at least 23 patients are needed in each group. Considering that 20% of the data may have been lost, our study included 28 patients in both groups. STATISTICAL ANALYSIS Statistical analyses were conducted by using the Jamovi [version 2.3.28] and JASP [version 0.17.3] programs. Descriptive statistics were used to summarize the data. Continuous [numerical] variables from the study are shown in the tables as the mean ± standard deviation or median, minimum, or maximum based on the distribution. Categorical variables are summarized as percentages and numbers. The normality of the numerical variables was analysed by using the Shapiro‒Wilk, Kolmogorov‒Smirnov and Anderson‒Darling tests. Pearson chi-square tests were used in 2x2 tables when the expected number was 5 and above to compare the differences in the categorical variables. Fisher's exact test was used for the tables when the expected numbers were less than 5. The Fisher Freeman Halton test was used for the RxC tables when the expected numbers were less than 5. For the comparison of two independent groups, an independent sample t test was used for the normally distributed variables, while the Mann‒Whitney U test was used for the normally distributed variables. For the statistical comparisons of the measurements made at the 1st, 2nd, 6th, 12th and 24th hours, repeated-measures ANOVA [and the nonparametric] Friedman test were used when the numerical variables were not normally distributed. The differences between the groups according to the nonparametric test were evaluated by using the Durbin-Conover test. For the statistical analyses, the significance level was accepted as 0.05 [p value]. Results For our study, 71 patients were scanned. Three patients did not agree to participate in the study, while 2 patients were not included due to the use of chronic opioids. In addition, 3 patients were excluded from the study during their follow-up, and 1 patient was removed from the study because of reoperation due to postoperative bleeding. As a result, total of 62 patients completed the study (Figure 1). The demographic data of the patients were similar. The demographic data are shown in Table 1. Table 1. Descriptive statistics of demographic characteristics of the TAP and QLB groups TAP Block (n=32) QLB Block (n=30) P Age * (years± SD) 63.5 ± 4.4 62.9 ± 3.6 0.556*** BMI (kg/m²± SD) * 23.8 ± 1.6 24.2 ± 1.5 0.270*** ASA Score ‡ I 12 (37.5) 13 (43.3) 0.716** II 12 (37.5) 12 (40.0) III 8 (25.0) 5 (16.7) TAP block: Transversus plane block. SD: Standart deviation *: mean±standard deviation, §: median [min–max], †: n (%) QLB: Quadratus lumborum block ** Pearson Chi-Square, Fisher's Exact or Fisher Freeman Halton test. BMI: Body Mass Index *** Independent Samples T Test. ASA: American Society of Anesthesiology The mean age of the patients was 63.2±4 years, and the mean body mass index [(BMI)] was 24.0±1.6 kg/m². Twentyfive [40.3%] patients had an ASA score of I, 24 [38.7%] II and 13 [21%] III [Table 1]. The mean paracetamol dose was 2000 mg in 56 [90.3%] of the patients. Ten [16.1%] of the patients were administered diclofenac, for a mean consumption of 50 mg. In the postoperative period, 48 [77.4%] of the patients needed additional analgesics. The need for analgesics was observed at the 2nd hour following surgery. Eighteen [29%] of patients needed opioids, for a mean dose of 100 mg. The mean postoperative satisfaction score was calculated as 8/10. The use of diclofenac was more common in the TAP group [p=0.013]; however, the use and dose of paracetamol, need for postoperative analgesics, time until the postoperative analgesic need, use and dose of opioids and patient satisfaction scores were similar in the TAP and QLB block groups [p>0.05 for all] [Table 2]. Table 2. Analgesic requirements of patients in the TAP and QLB block groups TAP Block (n=32) QLB Block (n=30) p T † 13.0 [11.5 – 17.0] 13.0 [10.3 – 16.3] 0.375* Paracetamol Use, yes ‡ (%) 30 (93.8%) 26 (86.7%) 0.418** Paracetamol Quantity † 2000.0 [1000.0– 3000.0] 2000.0 [1000.0 – 3000.0] 0.738* Diclofenac Use, yes ‡ 9 (28.1) 1 (3.3) 0.013** Demand of Diclofenac Sodyum † 1.0 [1.0 – 2.0] 1.0 [1.0 – 1.0] 0.999* Postoperative Analgesic Request Status, yes ‡ 26 (81.2) 22 (73.3) 0.659** Postoperative Analgesic Request Status, yes ‡ Postoperative first analgesic requested time † 26 (81.2) 2.0 [1.0 – 12.0] 22 (73.3) 2.0 [1.0 – 6.0] 0.659** 0.567* Opioid Use, yes ‡ 8 (25.0) 10 (33.3) 0.658** Opioid Quantity † 100.0 [100.0 – 200.0] 150.0 [100.0 – 300.0] 0.277* Patient Satisfaction † 8.0 [2.0 – 10.0] 8.5 [4.0 – 10.0] 0.336* TAP block: Transversus plane block. *: mean±standard deviation, †median [min–max], ‡: n (%). *. Mann‒Whitney U test. QLB: Quadratus lumborum block. **. Pearson’s chi-square test, Fisher's exact test or Fisher’s Freeman Halton test were used. ***. Independent Samples T Test The pain severity scores obtained at the 1st, 2nd, 6th, 12th and 24th postoperative hours were similar between the TAP and QLB groups [(p>0.05)]. The change in pain scores was determined to be statistically significant [(p< 0.001)] [(Table 3]). Table 3. Follow-up of the change in postoperative pain intensity in radical prostatectomy patients treated with TAP and QLB blocks TAP Block (n=32) QLB Block (n=30) p* Pain Score † 1st Hour 2.0 [0.0 – 10.0] 1.0 [0.0 – 8.0] 0.396 2nd Hour 4.0 [0.0 – 9.0] 4.0 [0.0 – 8.0] 0.874 6th Hour 2.0 [0.0 – 9.0] 2.0 [0.0 – 6.0] 0.632 12th Hour 2.0 [0.0 – 9.0] 1.0 [0.0 – 8.0] 0.154 24th Hour 1.0 [0.0 – 9.0] 1.0 [0.0 – 8.0] 0.522 p** <0.001 <0.001 TAP block: Transversus plane block. QLB: Quadratus lumborum block. **. Friedman test. †: median [min–max]. *. Mann‒Whitney U test. In both groups, pain increased from the first hour to the second hour but decreased at the sixth hour. The pain severity level measured at the 6th hour was similar to that measured at the 12th hour; however, a significant decrease was observed at the 24th hour. When the pain scores of the patients who underwent TAP block were compared based on different follow-up periods, the pain severity at the 2nd hour was significantly greater than that at the 1st hour (p<0.001). However, the pain severity measured at the 6th hour was significantly lower than that measured at the 2nd hour (p<0.001). The pain scores obtained at the 6th hour were similar to the pain scores obtained at the 12th hour (p=0.272); however, the pain severity measured at the 24th hour decreased significantly compared to that measured at the 12th hour (p=0.029). The pain severity measured at the 1st hour was similar to the pain severity measured at both the 6th and 12th hours in the TAP group (p=0.793 and p=0.174, respectively); however, the pain severity measured at the 24th hour was significantly lower than that measured at the 1st hour (p<0.001). The pain scores obtained at the 2nd hour were significantly greater than those obtained at all subsequent measurements [at the 6th, 12th and 24th hours] (p<0.001). Furthermore, the pain severity measured at the 6th hour was significantly greater than that measured at the 24th hour (p=0.001) (Table 4). Table 4. Pairwise comparisons TAP Block QLB Block p p 1st Hour Pain Score 2nd Hour Pain Score <0.001 <0.001 1st Hour Pain Score 6th Hour Pain Score 0.793 0.346 1st Hour Pain Score 12th Hour Pain Score 0.174 0.405 1st Hour Pain Score 24th Hour Pain Score <0.001 0.002 2nd Hour Pain Score 6th Hour Pain Score <0.001 <0.001 2nd Hour Pain Score 12th Hour Pain Score <0.001 <0.001 2nd Hour Pain Score 24th Hour Pain Score <0.001 <0.001 6th Hour Pain Score 12th Hour Pain Score 0.272 0.077 6th Hour Pain Score 24th Hour Pain Score 0.001 <0.001 12th Hour Pain Score 24th Hour Pain Score 0.029 0.021 TAP block: Transversus plane block. QLB: Quadratus lumborum block. *. Durbin-Conover Test. When the pain scores of the patients who underwent QLB were compared pairwise based on different follow-up periods, it was observed that the pain severity measured at the 2nd hour was significantly greater than that measured at the 1st hour (p<0.001). However, a significant decrease in pain severity was observed at the 6th hour compared to the 2nd hour (p<0.001). The pain scores obtained at the 6th hour were similar to those obtained at the 12th hour (p=0.077); however, the pain severity measured at the 24th hour was significantly lower than that measured at the 12th hour (p=0.021). In the QLB group, the pain severity measured at the 1st hour was consistent with the pain severity at both the 6th and 12th hours (p=0.346 and p=0.405, respectively). However, the pain severity measured at the 24th hour was significantly lower than that measured at the 1st hour (p=0.002). The pain scores obtained at the 2nd hour were significantly greater (p<0.001) than those obtained at all subsequent hours [for the 6th, 12th and 24th hours]. Furthermore, the pain severity measured at the 6th hour was significantly greater than that measured at the 24th hour (p<0.001) (Table 4). No complications were observed in both groups in the postoperative period. DISCUSSION Our study revealed no difference between the groups in terms of postoperative 24-hour tramadol consumption in patients who underwent TAP block or QLB block for postoperative analgesia following radical prostatectomy. Sixty-two patients who underwent TAP block and QLB for postoperative analgesia in radical prostatectomy operations were included in the study. In the postoperative period, 8 patients in the TAP block group and 10 patients in the QLB block group were administered opioids; however, no statistically significant difference was observed between the two groups in this regard. The dose of opioids was also similar in both groups [100–150 mg]. Dost et al. compared erector spinae plane blocks and placebo groups in open radical prostatectomy operations and revealed that opioid consumption was similar between the two groups in the first 24 hours after surgery [ 22 ]. A meta-analysis [ 23 ] comparing the effectiveness of TAP block and QLB blocks in cesarean operations reported that there was no difference between the groups in terms of opioid consumption in the first 24 hours after surgery, similar to the findings of our study. Similarly, no difference was observed between the two groups in terms of the tramadol used during the postoperative period following QLB or TAP block during varicocelectomy operations [ 20 ]. Tejedor et al. compared this technique with the epidural analgesia technique to investigate the effectiveness of TAP block in laparoscopic prostatectomy operations and reported that it had the same analgesic quality and enabled optimal pain control [ 26 ]. In addition, Dal Moro et al. emphasized that TAP block provided highly effective analgesia in the first 24 hours after surgery in patients who underwent robotic radical prostatectomy, and the need for opioids decreased during their postoperative 24-hour follow-up (when tramadol was used at 200 mg/24 hours) [ 27 ]. Although studies have reported that TAP and QLB blocks reduce postoperative opioid consumption during urological surgeries during the postoperative period, other studies argue that they have no effect on opioid consumption [ 24 , 25 ]. Skjelsager et al. (24] argued that subcutaneous wound infiltration via TAP block did not reduce opioid consumption [15 mg/24 h morphine] following open radical prostatectomy and could not prove the effectiveness of the block [ 24 ]. Horosz et al. [ 25 ] compared posterior QLB and placebo groups in minimally invasive radical prostatectomy patients and detected no difference in opioid consumption in the first postoperative 24-hour [posterior QLB group; 11.91 mg, placebo group; 9.5 mg oxycodone]. According to the PROSPECT guidelines [ 6 ], pain management was evaluated during the postoperative period in patients who underwent prostatectomy for cancer, and there was no difference between opioid use and pain scores during robotic prostatectomy when paracetamol was compared with the control group; however, the length of hospital stay decreased in the paracetamol group. The PROSPECT guidelines recommend the use of paracetamol, opioids and nonsteroidal anti-inflammatory analgesics during the postoperative period in patients with no contraindications. Paracetamol and diclofenac sodium were used in our study in patients who needed postoperative analgesia [for those with NRS scores above 5]. In our study, the use of diclofenac sodium was more common in the TAP group than in the control group (p = 0.013), for which the mean dose was 75 mg. However, the duration and dose of paracetamol and need for postoperative analgesics were similar between the two groups. Amer et al. compared bilateral QLB and TAP block following laparoscopic cholecystectomy and reported that bilateral QLB block was more effective than was TAP block [ 28 ]. Although Amer et al. carried out a study on laparoscopic cholecystectomy, they reported the first rescue analgesic demand time as 6 hours in the TAP group and 12 hours in the QLB group. In our study, the pain severity scores of the groups during the postoperative period were similar. However, when the pain scores of the groups were compared within themselves, the highest pain scores in both the TAP group and the QLB group were observed at the second postoperative hour, and the first analgesic demand was at the second postoperative hour. Like in our study, they argued that opioid consumption was highest in the first 6 hours in patients who underwent QLB in radical prostatectomy operations [ 25 ]. As recommended in the PROSPECT [ 6 ] guide, our study also evaluated patient satisfaction. However, our patients could not adapt to the postoperative satisfaction scale; therefore, we asked them to score out of 10, similar to the NRS score, since we could teach the NRS score in an easier way to evaluate postoperative satisfaction [1; quiet unsatisfied, 10: highly satisfied]. The mean patient satisfaction in both groups was 8 [in group 1:8 and group 2:8.5], and there was no difference between the groups. In our study, no significant difference was detected between the TAP or QLB block group in terms of pain severity at various hours following surgery. In a study comparing bilateral QLB and bilateral subcostal TAP blocks for postoperative analgesia in laparoscopic cholecystectomy patients, it was observed that bilateral QLB blocks were more effective; however, the difference in pain scores between the two blocks was not significant [ 28 ]. These findings are consistent with our study. The operation time was also similar between the two groups. This could be related to the fact that both blocks were performed in the supine position. The fact that our patients could not adapt to the sociocultural satisfaction score and that we did not perform dermatome analysis in our patients can be reported as limitations of our study. The lack of complications in our postoperative follow-up visits suggested that our communication with this surgery may be insufficient. CONCLUSION Our study concluded that there was no significant difference between TAP or QLB blocks performed to reduce the use of postoperative opioids. Minimizing the risk of intraperitoneal injection and intestinal injury as well as easily performing the procedure in the supine position are seen as advantages of ultrasound guided posterior QLB. Similarly, performing a TAP block in the supine position is both uncomplicated and safe. Accordingly, clinicians should use the blocks they are experiencing based on the needs and preferences of the patients. Declarations DATA AVAILABILITY STATEMENT The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Funding: None Author Contribution All authors: Study Conception and design, Final Approval of the Version to be Published E.Y. and B.A. : Data Processing, Collection, Perform ExperimentA.P. and I.A.: Analysis and Interpretation of resultsE.Y. and B.A. : Draft Manuscript Preparation, VisualizationB.U.: Supervision, Funding Acquisition Acknowledgments: None Previous presentation in conferences: None Conflict of interest: The authors declare no conflict of interest. Funding: None Acknowledgments: None IRB number : 10/27/2021- 22/III Clinical trial registration number: NCT06075498- 10/10/2023 References Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71:209–49. https://doi.org/10.3322/CAAC.21660 . Van Everaerts PH, Tosco W, Joniau L. Open and robotic radical prostatectomy. 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Role of ultrasound guided transversus abdominis plane block as a component of multimodal analgesic regimen for lower segment caesarean section: A randomized double blind clinical study. BMC Anesthesiol. 2018;18:1–7. https://doi.org/10.1186/S12871-018-0512-X/FIGURES/3 . Hain E, Maggiori L, Prost à la Denise J, Panis Y. Transversus abdominis plane (TAP) block in laparoscopic colorectal surgery improves postoperative pain management: a meta-analysis. Colorectal Dis. 2018;20:279–87. https://doi.org/10.1111/CODI.14037 . Blanco R. 271. Tap block under ultrasound guidance: the description of a no pops technique. Reg Anesth Pain Med 2007; 32:130–130. https://doi.org/10.1136/RAPM-00115550-200709001-00249 . El-Boghdadly, K., Wolmarans, M., Stengel, A. D., Albrecht, E., Chin, K. J., Elsharkawy,H., … Elkassabany, N. M. Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of abdominal wall, paraspinal, and chest wall blocks. 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Single injection Quadratus Lumborum block for postoperative analgesia in adult surgical population: A systematic review and meta-analysis. J Clin Anesth. 2020;62. https://doi.org/10.1016/J.JCLINANE.2020.109715 . Priyadarshini K, Behera BK, Tripathy BB, Misra S. Ultrasound-guided transverse abdominis plane block, ilioinguinal/iliohypogastric nerve block, and quadratus lumborum block for elective open inguinal hernia repair in children: a randomized controlled trial. Reg Anesth Pain Med. 2022;47. https://doi.org/10.1136/RAPM-2021-103201 . Hu Z, Zhou Y, Zhao G, Zhang X, Liu C, Xing H, et al. Effects of quadratus lumborum block on perioperative multimodal analgesia and postoperative outcomes in patients undergoing radical prostatectomy. BMC Anesthesiol. 2022;22:1–8. https://doi.org/10.1186/S12871-022-01755-W/TABLES/3 . Öncü G, Boran ÖF, Çalışır F, Orak Y, Bilal B, Öksüz H. Comparison of the postoperative analgesic effect of transversus abdominis plan block and quadratus lumborum block: A prospective randomized study. Health Sci Rep. 2022;5:e752. https://doi.org/10.1002/hsr2.752 . Sertcakacilar G, Yildiz GO. Analgesic efficacy of ultrasound-guided transversus abdominis plane block and lateral approach quadratus lumborum block after laparoscopic appendectomy: A randomized controlled trial. Annals Med Surg. 2022;79:104002. https://doi.org/10.1016/j.amsu.2022.1004002 . Dost B, Kaya C, Ozdemir E, Ustun YB, Koksal E, Bilgin S, Bostancı Y. Ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing open radical prostatectomy: a randomized, placebo-controlled trial. J Clin Anesth. 2021;72:110277. 10.1016/j.jclinane.2021.110277 . El-Boghdadly K., Desai N., Halpern S., Blake L., Odor P. M., Bampoe S., … Sultan P.Quadratus lumborum block vs. transversus abdominis plane block for caesarean delivery:a systematic review and network meta‐analysis. Anaesthesia, 2021, 76.3: 393–403. doi.org/10.1111/anae.15160. Skjelsager A, Ruhnau B, Kistorp TK, Kridina I, Hvarness H, Mathiesen O, Dahl JB. Transversus abdominis plane block or subcutaneous wound infiltration after open radical prostatectomy: a randomized study. Acta Anaesthesiol Scand. 2013;57(4):502–8. https://doi.org/10.1111/aas.12080 . Horosz B, Bialowolska K, Kociuba A, Dobruch J, Malec-Milewska M. Ultrasound–guided posterior quadratus lumborum block for postoperative pain control after minimally invasive radical prostatectomy: a randomized, double–blind, placebo–controlled trial. Excli J. 2022;21:335–43. 10.17179/excli2021-4615 . Tejedor A, Deiros C, García M, Vendrell M, Gómez N, Gómez E, Masdeu J. Comparison between epidural technique and mid-axillary ultrasound-guided TAP block for postoperative analgesia of laparoscopic radical prostatectomy: a quasi-randomized clinical trial. Brazilian J Anesthesiology. 2022;72:253–60. Dal Moro F, Aiello L, Pavarin P, Zattoni F. Ultrasound-guided transversus abdominis plane block (US-TAPb) for robot-assisted radical prostatectomy: a novel ‘4-point’technique—results of a prospective, randomized study. J robotic Surg. 2019;13:147–51. Amer DA, Abo Elnasr LM, Ezz HA, Abdullah MA. Pre-emptive analgesic effect of ultrasound-guided quadratus lumborum block versus transversus abdominis plane block in laparoscopic cholecystectomy. Tanta Med J. 2022;50:217–23. https://doi.org/10.4103/tmj_81_20 . Additional Declarations No competing interests reported. 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Yasar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYFAC5gYIzcPAcOADkGZjJ6iFEaglAaLl4AyQFmZStDDzgK0loIFfIrHx0c0fdvn8PYcfHrb5tU2ej5mB8cPHHNxaJGckNhvnJCRbzjjbZnA4t++2YRszA7PkzG24tRjcSGyTzklgNmA4z8NwOLfnNiNQCxszLx4t9jcS23/nJNQbyIO0WPbctieoxUAisY05J+GwgcHZHobDDD9uJxLUInHmYbN0TtpxA8MzxwwO9jbcTm5jZmzG6xf+9uSDn3Nsqg3kziQ//vDjz23b+e3NBz98xKOFQSABicPYBiYb8KgHWXMAmfcHv+JRMApGwSgYmQAAk3RThnlEgYgAAAAASUVORK5CYII=","orcid":"","institution":"Muğla University","correspondingAuthor":true,"prefix":"","firstName":"Eylem","middleName":"","lastName":"Yasar","suffix":""},{"id":273640334,"identity":"e1dd4e27-5fb9-4448-bb56-2c21a80dac0c","order_by":1,"name":"Basak Altiparmak","email":"","orcid":"","institution":"Muğla University","correspondingAuthor":false,"prefix":"","firstName":"Basak","middleName":"","lastName":"Altiparmak","suffix":""},{"id":273640335,"identity":"53e4bcbc-324b-4bfb-be3e-4cd94884442e","order_by":2,"name":"Ahmet Pinarbasi","email":"","orcid":"","institution":"Muğla University","correspondingAuthor":false,"prefix":"","firstName":"Ahmet","middleName":"","lastName":"Pinarbasi","suffix":""},{"id":273640336,"identity":"6771e20c-1557-4e29-abb0-ffcfba3711a9","order_by":3,"name":"Ilker Akarken","email":"","orcid":"","institution":"Muğla University","correspondingAuthor":false,"prefix":"","firstName":"Ilker","middleName":"","lastName":"Akarken","suffix":""},{"id":273640337,"identity":"5c5f6988-3661-454b-aeab-2d8cda7fca9c","order_by":4,"name":"Bakiye Ugur","email":"","orcid":"","institution":"Muğla University","correspondingAuthor":false,"prefix":"","firstName":"Bakiye","middleName":"","lastName":"Ugur","suffix":""}],"badges":[],"createdAt":"2024-01-23 07:59:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3890353/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3890353/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51445756,"identity":"51c5b048-5fcc-467d-b031-2901357ce407","added_by":"auto","created_at":"2024-02-21 18:11:30","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":427167,"visible":true,"origin":"","legend":"\u003cp\u003eConsort diagram\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3890353/v1/21650bdab750f389cbb9ef0d.jpeg"},{"id":54468521,"identity":"3f37ec3e-a4c0-4ae0-8a68-f1007115d1af","added_by":"auto","created_at":"2024-04-11 03:52:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":460110,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3890353/v1/56eb6926-d97f-4b33-8858-310f1cc1cc62.pdf"},{"id":51445755,"identity":"ca5213eb-a27c-4a4e-9b98-1c6bd6bdd2cb","added_by":"auto","created_at":"2024-02-21 18:11:30","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":224256,"visible":true,"origin":"","legend":"","description":"","filename":"consort2010checklist.doc","url":"https://assets-eu.researchsquare.com/files/rs-3890353/v1/541d0c5f9227503717358a18.doc"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of the analgesic efficacy of transversus abdominis plane block and posterior approach quadratus lumborum block after open radical retropubic prostatectomy: a randomized controlled trial","fulltext":[{"header":"WHAT IS KNOWN","content":"\u003col\u003e\n \u003cli\u003eTo compare the analgesic efficacy and opioid consumption of the two groups within 24 hours postoperatively: first point.\u003c/li\u003e\n \u003cli\u003eDuration of sensory block, opioid-related side effects (postoperative nausea and vomiting, itching, sedation), patient satisfaction and complications related to the block: second point.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eWHAT IS NEW\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe hope to contribute to the literature on peripheral nerve blocks used for effective analgesia in open retropubic prostatectomy operations: the third point.\u003c/p\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eProstate cancer is the second most common type of cancer in males worldwide according to 2020 data, and surgery is a commonly preferred method for treating prostate cancer [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although robotic radical prostatectomy has gained popularity in recent years due to technological developments, open retropubic radical prostatectomy is still a common treatment method for locally advanced prostate cancer [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Open radical prostatectomy has been found to be related to moderate pain in the early postoperative period [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, postoperative pain, which is not controlled by surgery, can prolong the length of hospital stay [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The procedure-specific postoperative pain management [PROSPECT] published by Lemoine et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] suggested that regional techniques such as wound infiltration and transversus abdominis plane [TAP] block are also recommended as a part of multimodal analgesia in addition to pharmacological methods such as paracetamol, nonsteroidal anti-inflammatory drugs and systemic lidocaine infusion following radical prostatectomy.\u003c/p\u003e \u003cp\u003eTransversus abdominis plane block is an effective regional analgesia technique. In this method, the sensory afferents of the anterior abdominal wall are blocked at the level of the seventh thoracic and first lumbar vertebra. TAP blocks can be effectively used in various abdominal surgical procedures, such as colorectal surgery, inguinal and umbilical hernia repair, cesarean section, and radical prostatectomy [\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn 2007, the quadratus lumborum block [QLB] was defined by Blanco as a variant of the TAP block [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The blocks, which were previously named QLB-1, QLB-2 and QLB-3 based on the anatomical region of the local anaesthetic injection, were first known as the anterior, lateral, and posterior QLB, respectively, after the Delphy consensus on abdominal wall blocks was published in 2021 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The posterior QLB is the block created by injecting between the erector spinae muscle and quadratus lumborum muscle [posterior to the quadratus lumborum muscle]. The local anaesthetic agent has been reported to produce analgesia from thoracic 7 to lumbar 1 by extending into the thoracic paravertebral space or thoracolumbar plane [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. QLB is used as a part of multimodal analgesia for managing postoperative analgesia in both adults and pediatric patients during abdominal surgeries, such as cesarean section, renal surgery and inguinal hernia repair [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Although studies have focused on the use of anterior QLB following open radical prostatectomy, the number of studies conducted on the effect of posterior QLB is limited [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe aim of this study was to compare the effects of TAP block performed as a part of multimodal analgesia and posterior QLB on postoperative opioid consumption, time to analgesic requirement, patient pain, and satisfaction scores after open radical prostatectomy. Based on our hypothesis, posterior QLB block via ultrasonography after open radical prostatectomy will reduce opioid consumption within 24 hours after surgery compared to TAP block.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThis was a randomized and double-blinded controlled trial with two parallel arms. The study was conducted at Mugla Training and Research Hospital. The study protocol was approved by the Clinical Trials Ethics Committee of Mugla Sıtkı Kocman University [date 27/10/2021, no 22/III] and registered in the clinical trials.gov [Id: NCT06075498- Trial registration:10/10/2023 ] in October. Written informed consent was obtained from all participants. This study adhered to the 2010 Consolidated Standards of Reporting Trials [CONSORT] guidelines. ASA [American Society of Anaesthesiology classification] I-II-III patients who underwent open prostatectomy surgery under general anaesthesia were included in the study. The ages of the patients were between 18 and 70 years. Patients who refused to participate in the study, were ASA IV, had allergies to study drugs, had any contraindication for regional technique, had coagulation disorders or injection site infections, had chronic analgesic use, could not adapt to the numerical assessment scale [NRS score] or had a body mass index [BMI] above 35 kg/m\u003csup\u003e2\u003c/sup\u003e were excluded from the study. After the patients were taken to the operating room, standard monitoring [electrocardiography, noninvasive blood pressure measurements, and peripheral oxygen saturation] were conducted, and peripheral intravenous access was administered. Standard anaesthesia management was performed with 1.5-3 mg/kg propofol, 1\u0026ndash;2 mcg/kg fentanyl and 0.6 mg/kg rocuronium bromide based on the needs of the patients. Heart rate, ECG, noninvasive blood pressure, peripheral oxygen saturation, capnography and bispectral index [BIS] were preoperatively monitored every 15 minutes. For anaesthesia maintenance, 1 MAC desflurane, 0.4/0.6 oxygen air mixture and 0.1\u0026ndash;0.2 mcg/kg/min remifentanil infusion were applied to sustain the bispectral index between 45 and 60. Half an hour before terminating the operation, 50 mg of dexketoprofen, 1 mg/kg tramadol for analgesic purposes and 0.1 mg/kg ondansetron for antiemetic purposes were intravenously administered to all patients. Following the surgery, the patients were randomly divided into 2 groups before terminating anaesthesia. After the location of the block was prepared with chlorhexidine in the patients in the first group [of the TAP group], a 5\u0026ndash;13 MHz linear probe (SonoSite MTurbo; Fujifilm SonoSite, Bothell, WA) was placed parallel to the anterior axillary line on the iliac crest. Afterwards, a 22-gauge block needle was used to move the needle from anterior to posterior via the in-plane method. After a minimal resistance loss was observed upon entering the facial plane between the external and internal oblique muscle layers, 1\u0026ndash;2 mL of saline was injected, and the needle was confirmed to be in the interfacial area. A total of 0.375% mg of bupivacaine was injected into the patients. The same procedure was also applied to the other group. In the second group, [the QLB group], after the skin was sterilized, the convex ultrasound probe was placed perpendicular to the spine in the 12th vertebral body and then advanced laterally to visualize the quadratus lumborum muscle and psoas muscle. By using the in-plane method, a 22-gauge needle was injected between the quadratus lumborum muscle and anterior layer of the thoracolumbar fascia with 1\u0026ndash;2 mL of saline and 20 mL of 0.375% mg of bupivacaine. The same procedure was also repeated for the other group. Following the blocking procedure, the volatile agent treatment was terminated in both groups. After recurrence, the patients were extubated and taken to the postoperative recovery unit.\u003c/p\u003e \u003cp\u003eA research assistant blinded to the group distribution evaluated the pain level of the patients at the 1st, 2nd, 6th, 12th and 24th postoperative hours by using the numeric rating scale (NRS). For patients whose NRS score was above 5 for half an hour, 100 mg of tramadol was administered. The use of tramadol, which is a nonsteroidal anti-inflammatory medication, was followed for 24 hours. Moreover, complications such as local anaesthesia toxicity, allergies, internal organ injury, postoperative bleeding and postoperative nausea and vomiting were recorded. Patients were evaluated for their satisfaction with the anaesthesia method during the postoperative period as follows: [1, quite unsatisfied; 10, highly satisfied].\u003c/p\u003e \u003cp\u003eThe sample size of the study was calculated by using the G*Power program [v3.1.9]. The sample size was estimated based on the 24-hour tramadol dose needed for patients who underwent open prostatectomy surgery. A previous study revealed that there was a 20% decrease in 24-hour tramadol use between two groups of patients, according to the sample size [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Accordingly, when the α error\u0026thinsp;=\u0026thinsp;0.05 and the power are 80%, at least 23 patients are needed in each group. Considering that 20% of the data may have been lost, our study included 28 patients in both groups.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSTATISTICAL ANALYSIS\u003c/h2\u003e \u003cp\u003eStatistical analyses were conducted by using the Jamovi [version 2.3.28] and JASP [version 0.17.3] programs. Descriptive statistics were used to summarize the data. Continuous [numerical] variables from the study are shown in the tables as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median, minimum, or maximum based on the distribution. Categorical variables are summarized as percentages and numbers. The normality of the numerical variables was analysed by using the Shapiro‒Wilk, Kolmogorov‒Smirnov and Anderson‒Darling tests.\u003c/p\u003e \u003cp\u003ePearson chi-square tests were used in 2x2 tables when the expected number was 5 and above to compare the differences in the categorical variables. Fisher's exact test was used for the tables when the expected numbers were less than 5. The Fisher Freeman Halton test was used for the RxC tables when the expected numbers were less than 5.\u003c/p\u003e \u003cp\u003eFor the comparison of two independent groups, an independent sample t test was used for the normally distributed variables, while the Mann‒Whitney U test was used for the normally distributed variables.\u003c/p\u003e \u003cp\u003eFor the statistical comparisons of the measurements made at the 1st, 2nd, 6th, 12th and 24th hours, repeated-measures ANOVA [and the nonparametric] Friedman test were used when the numerical variables were not normally distributed. The differences between the groups according to the nonparametric test were evaluated by using the Durbin-Conover test. For the statistical analyses, the significance level was accepted as 0.05 [p value].\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFor our study, 71 patients were scanned. Three patients did not agree to participate in the study, while 2 patients were not included due to the use of chronic opioids. In addition, 3 patients were excluded from the study during their follow-up, and 1 patient was removed from the study because of reoperation due to postoperative bleeding. As a result, total of 62 patients completed the study (Figure 1).\u003c/p\u003e\n\u003cp\u003eThe demographic data of the patients were similar. The demographic data are shown in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1. Descriptive statistics of demographic characteristics of\u0026nbsp;the\u0026nbsp;TAP and QLB groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTAP Block\u003cbr\u003e\u0026nbsp;(n=32)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eQLB Block\u003cbr\u003e\u0026nbsp;(n=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge \u003csup\u003e*\u0026nbsp;\u003c/sup\u003e(years\u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\" valign=\"top\"\u003e\n \u003cp\u003e63.5 \u0026plusmn; 4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\" valign=\"top\"\u003e\n \u003cp\u003e62.9 \u0026plusmn; 3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e0.556***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (kg/m\u0026sup2;\u0026plusmn; SD) \u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\" valign=\"top\"\u003e\n \u003cp\u003e23.8 \u0026plusmn; 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\" valign=\"top\"\u003e\n \u003cp\u003e24.2 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e0.270***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA Score \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\" valign=\"top\"\u003e\n \u003cp\u003e12 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\" valign=\"top\"\u003e\n \u003cp\u003e13 (43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e0.716**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eII\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\" valign=\"top\"\u003e\n \u003cp\u003e12 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\" valign=\"top\"\u003e\n \u003cp\u003e12 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIII\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\" valign=\"top\"\u003e\n \u003cp\u003e8 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\" valign=\"top\"\u003e\n \u003cp\u003e5 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eTAP block: Transversus plane block. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; SD: Standart deviation\u003c/p\u003e\n \u003cp\u003e*: mean\u0026plusmn;standard deviation, \u0026sect;: median [min\u0026ndash;max],\u0026nbsp;\u0026dagger;: n (%) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; QLB: Quadratus lumborum block\u003c/p\u003e\n \u003cp\u003e** Pearson Chi-Square, Fisher\u0026apos;s Exact or Fisher Freeman Halton test. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; BMI: Body Mass Index\u003c/p\u003e\n \u003cp\u003e*** Independent Samples T Test. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;ASA: American Society of Anesthesiology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe mean age of the patients was 63.2\u0026plusmn;4 years, and the mean body mass index\u0026nbsp;[(BMI)]\u0026nbsp;was 24.0\u0026plusmn;1.6 kg/m\u0026sup2;. Twentyfive\u0026nbsp;[40.3%]\u0026nbsp;patients had an ASA score of I, 24\u0026nbsp;[38.7%]\u0026nbsp; II and 13\u0026nbsp;[21%]\u0026nbsp; III\u0026nbsp;[Table 1].\u003c/p\u003e\n\u003cp\u003eThe mean paracetamol dose was 2000 mg in 56\u0026nbsp;[90.3%]\u0026nbsp;of the patients. Ten\u0026nbsp;[16.1%]\u0026nbsp;of the patients were administered diclofenac, for a mean consumption of 50 mg. In the postoperative period, 48\u0026nbsp;[77.4%]\u0026nbsp;of the patients needed additional analgesics. The need for analgesics was observed at the 2nd hour following surgery. Eighteen\u0026nbsp;[29%]\u0026nbsp;of patients needed opioids, for a mean dose of 100 mg. The mean postoperative satisfaction score was calculated as\u0026nbsp;8/10. The use of diclofenac was more common in the TAP group\u0026nbsp;[p=0.013]; however, the use and dose of paracetamol, need for postoperative analgesics, time until the postoperative analgesic need, use and dose of opioids and patient satisfaction scores were similar in the TAP and QLB block groups\u0026nbsp;[p\u0026gt;0.05 for all]\u0026nbsp;\u0026nbsp;[Table 2].\u003c/p\u003e\n\u003cp\u003eTable 2. Analgesic requirements of patients\u0026nbsp;in the\u0026nbsp;TAP and QLB block groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTAP Block\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e(n=32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eQLB Block\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e(n=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\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=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eT\u003c/strong\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e13.0 [11.5 \u0026ndash; 17.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e13.0 [10.3 \u0026ndash; 16.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e0.375*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParacetamol Use, \u003cem\u003eyes\u003c/em\u003e\u0026nbsp;\u003c/strong\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e30 (93.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e26 (86.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e0.418**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParacetamol\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eQuantity\u0026nbsp;\u003c/strong\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e2000.0 [1000.0\u0026ndash; 3000.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e2000.0 [1000.0 \u0026ndash; 3000.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e0.738*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiclofenac Use,\u003cem\u003eyes\u003c/em\u003e\u0026nbsp;\u003c/strong\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e9 (28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e1 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemand of\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDiclofenac Sodyum\u0026nbsp;\u003c/strong\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e1.0 [1.0 \u0026ndash; 2.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e1.0 [1.0 \u0026ndash; 1.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e0.999*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative Analgesic Request Status, \u003cem\u003eyes\u003c/em\u003e\u0026nbsp;\u003c/strong\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e26 (81.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e22 (73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e0.659**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative Analgesic Request Status,\u003cem\u003e\u0026nbsp;yes\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative first analgesic requested time\u003c/strong\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e26 (81.2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;2.0 [1.0 \u0026ndash; 12.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e22 (73.3)\u003c/p\u003e\n \u003cp\u003e2.0 [1.0 \u0026ndash; 6.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e0.659**\u003c/p\u003e\n \u003cp\u003e0.567*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpioid Use, \u003cem\u003eyes\u003c/em\u003e\u0026nbsp;\u003c/strong\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 8 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 10 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e0.658**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpioid Quantity\u0026nbsp;\u003c/strong\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e100.0 [100.0 \u0026ndash; 200.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e150.0 [100.0 \u0026ndash; 300.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e0.277*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.69387755102041%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient Satisfaction\u0026nbsp;\u003c/strong\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 8.0 [2.0 \u0026ndash; 10.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;8.5 [4.0 \u0026ndash; 10.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e0.336*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTAP block: Transversus plane block. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;*:\u0026nbsp;mean\u0026plusmn;standard deviation,\u0026nbsp;\u0026dagger;median [min\u0026ndash;max], \u0026Dagger;: n (%). \u0026nbsp; \u0026nbsp; \u0026nbsp;*.\u0026nbsp;Mann‒Whitney\u0026nbsp;U test.\u003c/p\u003e\n\u003cp\u003eQLB: Quadratus lumborum block. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;**.\u0026nbsp;Pearson\u0026rsquo;s chi-square test, Fisher\u0026apos;s\u0026nbsp;exact test or Fisher\u0026rsquo;s\u0026nbsp;Freeman Halton test were used.\u003c/p\u003e\n\u003cp\u003e***. Independent Samples T Test\u003c/p\u003e\n\u003cp\u003eThe pain severity scores obtained at the 1st, 2nd, 6th, 12th and 24th postoperative hours were similar between the TAP and QLB groups\u0026nbsp;[(p\u0026gt;0.05)]. The change in pain scores was determined to be statistically significant\u0026nbsp;[(p\u0026lt; 0.001)]\u0026nbsp;[(Table 3]).\u003c/p\u003e\n\u003cp\u003eTable 3. Follow-up of the change in postoperative pain intensity in radical prostatectomy patients treated with TAP and QLB\u0026nbsp;blocks\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\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTAP Block\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e(n=32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eQLB Block\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e(n=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\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=\"26.53061224489796%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain Score\u0026nbsp;\u003c/strong\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\"\u003e\n \u003cp\u003e1st Hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\n \u003cp\u003e2.0 [0.0 \u0026ndash; 10.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\"\u003e\n \u003cp\u003e1.0 [0.0 \u0026ndash; 8.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e0.396\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\"\u003e\n \u003cp\u003e2nd Hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\n \u003cp\u003e4.0 [0.0 \u0026ndash; 9.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\"\u003e\n \u003cp\u003e4.0 [0.0 \u0026ndash; 8.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e0.874\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\"\u003e\n \u003cp\u003e6th Hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\n \u003cp\u003e2.0 [0.0 \u0026ndash; 9.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\"\u003e\n \u003cp\u003e2.0 [0.0 \u0026ndash; 6.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e0.632\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\"\u003e\n \u003cp\u003e12th Hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\n \u003cp\u003e2.0 [0.0 \u0026ndash; 9.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\"\u003e\n \u003cp\u003e1.0 [0.0 \u0026ndash; 8.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\"\u003e\n \u003cp\u003e24th Hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\n \u003cp\u003e1.0 [0.0 \u0026ndash; 9.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\"\u003e\n \u003cp\u003e1.0 [0.0 \u0026ndash; 8.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e0.522\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTAP block: Transversus plane block. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;QLB: Quadratus lumborum block. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; **. Friedman test.\u003c/p\u003e\n\u003cp\u003e\u0026dagger;: median [min\u0026ndash;max]. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;*.\u0026nbsp;Mann‒Whitney\u0026nbsp;U test.\u003c/p\u003e\n\u003cp\u003eIn both groups, pain increased from the first hour to the second hour but decreased at the sixth hour. The pain severity level measured at the 6th hour was similar to that measured at the 12th hour; however, a significant decrease was observed at the 24th hour. When the pain scores of the patients who underwent TAP block were compared based on different follow-up periods, the pain severity at the 2nd hour was significantly greater than that at the 1st hour (p\u0026lt;0.001). However, the pain severity measured at the 6th hour was significantly lower than that measured at the 2nd hour (p\u0026lt;0.001). The pain scores obtained at the 6th hour were similar to the pain scores obtained at the 12th hour (p=0.272); however, the pain severity measured at the 24th hour decreased significantly compared to that measured at the 12th hour (p=0.029). The pain severity measured at the 1st hour was similar to the pain severity measured at both the 6th and 12th hours in the TAP group (p=0.793 and p=0.174, respectively); however, the pain severity measured at the 24th hour was significantly lower than that measured at the 1st hour (p\u0026lt;0.001). The pain scores obtained at the 2nd hour were significantly greater than those obtained at all subsequent measurements\u0026nbsp;[at the 6th, 12th and 24th hours]\u0026nbsp;(p\u0026lt;0.001). Furthermore, the pain severity measured at the 6th hour was significantly greater than that measured at the 24th hour (p=0.001) (Table 4).\u003c/p\u003e\n\u003cp\u003eTable 4. Pairwise comparisons\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTAP Block\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e\u003cstrong\u003eQLB Block\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.591836734693878%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\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=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e1st Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003e2nd Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e1st Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003e6th Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e0.793\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e0.346\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e1st Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003e12th Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e0.405\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e1st Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003e24th Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e2nd Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003e6th Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e2nd Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003e12th Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e2nd Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003e24th Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e6th Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003e12th Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e0.272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e6th Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003e24th Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.591836734693878%\" valign=\"top\"\u003e\n \u003cp\u003e12th Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003e24th Hour Pain Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTAP block: Transversus plane block. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;QLB: Quadratus lumborum block. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; *. Durbin-Conover Test.\u003c/p\u003e\n\u003cp\u003eWhen the pain scores of the patients who underwent QLB were compared pairwise based on different follow-up periods, it was observed that the pain severity measured at the 2nd hour was significantly greater than that measured at the 1st hour (p\u0026lt;0.001). However, a significant decrease in pain severity was observed at the 6th hour compared to the 2nd hour (p\u0026lt;0.001). The pain scores obtained at the 6th hour were similar to those obtained at the 12th hour (p=0.077); however, the pain severity measured at the 24th hour was significantly lower than that measured at the 12th hour (p=0.021). In the QLB group, the pain severity measured at the 1st hour was consistent with the pain severity at both the 6th and 12th hours (p=0.346 and p=0.405, respectively). However, the pain severity measured at the 24th hour was significantly lower than that measured at the 1st hour (p=0.002). The pain scores obtained at the 2nd hour were significantly greater (p\u0026lt;0.001) than those obtained at all subsequent hours\u0026nbsp;[for the 6th, 12th and 24th hours]. Furthermore, the pain severity measured at the 6th hour was significantly greater than that measured at the 24th hour (p\u0026lt;0.001) (Table 4).\u003c/p\u003e\n\u003cp\u003eNo complications were observed in both groups in the postoperative period.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur study revealed no difference between the groups in terms of postoperative 24-hour tramadol consumption in patients who underwent TAP block or QLB block for postoperative analgesia following radical prostatectomy.\u003c/p\u003e \u003cp\u003eSixty-two patients who underwent TAP block and QLB for postoperative analgesia in radical prostatectomy operations were included in the study. In the postoperative period, 8 patients in the TAP block group and 10 patients in the QLB block group were administered opioids; however, no statistically significant difference was observed between the two groups in this regard. The dose of opioids was also similar in both groups [100\u0026ndash;150 mg]. Dost et al. compared erector spinae plane blocks and placebo groups in open radical prostatectomy operations and revealed that opioid consumption was similar between the two groups in the first 24 hours after surgery [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. A meta-analysis [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] comparing the effectiveness of TAP block and QLB blocks in cesarean operations reported that there was no difference between the groups in terms of opioid consumption in the first 24 hours after surgery, similar to the findings of our study. Similarly, no difference was observed between the two groups in terms of the tramadol used during the postoperative period following QLB or TAP block during varicocelectomy operations [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTejedor et al. compared this technique with the epidural analgesia technique to investigate the effectiveness of TAP block in laparoscopic prostatectomy operations and reported that it had the same analgesic quality and enabled optimal pain control [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In addition, Dal Moro et al. emphasized that TAP block provided highly effective analgesia in the first 24 hours after surgery in patients who underwent robotic radical prostatectomy, and the need for opioids decreased during their postoperative 24-hour follow-up (when tramadol was used at 200 mg/24 hours) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough studies have reported that TAP and QLB blocks reduce postoperative opioid consumption during urological surgeries during the postoperative period, other studies argue that they have no effect on opioid consumption [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Skjelsager et al. (24] argued that subcutaneous wound infiltration via TAP block did not reduce opioid consumption [15 mg/24 h morphine] following open radical prostatectomy and could not prove the effectiveness of the block [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Horosz et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] compared posterior QLB and placebo groups in minimally invasive radical prostatectomy patients and detected no difference in opioid consumption in the first postoperative 24-hour [posterior QLB group; 11.91 mg, placebo group; 9.5 mg oxycodone].\u003c/p\u003e \u003cp\u003eAccording to the PROSPECT guidelines [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], pain management was evaluated during the postoperative period in patients who underwent prostatectomy for cancer, and there was no difference between opioid use and pain scores during robotic prostatectomy when paracetamol was compared with the control group; however, the length of hospital stay decreased in the paracetamol group. The PROSPECT guidelines recommend the use of paracetamol, opioids and nonsteroidal anti-inflammatory analgesics during the postoperative period in patients with no contraindications. Paracetamol and diclofenac sodium were used in our study in patients who needed postoperative analgesia [for those with NRS scores above 5]. In our study, the use of diclofenac sodium was more common in the TAP group than in the control group (p\u0026thinsp;=\u0026thinsp;0.013), for which the mean dose was 75 mg. However, the duration and dose of paracetamol and need for postoperative analgesics were similar between the two groups. Amer et al. compared bilateral QLB and TAP block following laparoscopic cholecystectomy and reported that bilateral QLB block was more effective than was TAP block [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Although Amer et al. carried out a study on laparoscopic cholecystectomy, they reported the first rescue analgesic demand time as 6 hours in the TAP group and 12 hours in the QLB group. In our study, the pain severity scores of the groups during the postoperative period were similar. However, when the pain scores of the groups were compared within themselves, the highest pain scores in both the TAP group and the QLB group were observed at the second postoperative hour, and the first analgesic demand was at the second postoperative hour. Like in our study, they argued that opioid consumption was highest in the first 6 hours in patients who underwent QLB in radical prostatectomy operations [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs recommended in the PROSPECT [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] guide, our study also evaluated patient satisfaction. However, our patients could not adapt to the postoperative satisfaction scale; therefore, we asked them to score out of 10, similar to the NRS score, since we could teach the NRS score in an easier way to evaluate postoperative satisfaction [1; quiet unsatisfied, 10: highly satisfied]. The mean patient satisfaction in both groups was 8 [in group 1:8 and group 2:8.5], and there was no difference between the groups.\u003c/p\u003e \u003cp\u003eIn our study, no significant difference was detected between the TAP or QLB block group in terms of pain severity at various hours following surgery. In a study comparing bilateral QLB and bilateral subcostal TAP blocks for postoperative analgesia in laparoscopic cholecystectomy patients, it was observed that bilateral QLB blocks were more effective; however, the difference in pain scores between the two blocks was not significant [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. These findings are consistent with our study.\u003c/p\u003e \u003cp\u003eThe operation time was also similar between the two groups. This could be related to the fact that both blocks were performed in the supine position.\u003c/p\u003e \u003cp\u003eThe fact that our patients could not adapt to the sociocultural satisfaction score and that we did not perform dermatome analysis in our patients can be reported as limitations of our study. The lack of complications in our postoperative follow-up visits suggested that our communication with this surgery may be insufficient.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eOur study concluded that there was no significant difference between TAP or QLB blocks performed to reduce the use of postoperative opioids. Minimizing the risk of intraperitoneal injection and intestinal injury as well as easily performing the procedure in the supine position are seen as advantages of ultrasound guided posterior QLB. Similarly, performing a TAP block in the supine position is both uncomplicated and safe. Accordingly, clinicians should use the blocks they are experiencing based on the needs and preferences of the patients.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors: Study Conception and design, Final Approval of the Version to be Published E.Y. and B.A. : Data Processing, Collection, Perform ExperimentA.P. and I.A.: Analysis and Interpretation of resultsE.Y. and B.A. : Draft Manuscript Preparation, VisualizationB.U.: Supervision, Funding Acquisition\u003c/p\u003e\u003ch2\u003eAcknowledgments:\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e \u003cp\u003e\u003cstrong\u003ePrevious presentation in conferences:\u003c/strong\u003e None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e None\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIRB number\u003c/strong\u003e:\u0026nbsp;10/27/2021- 22/III\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration number:\u003c/strong\u003e NCT06075498- 10/10/2023\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. 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Excli J. 2022;21:335\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.17179/excli2021-4615\u003c/span\u003e\u003cspan address=\"10.17179/excli2021-4615\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTejedor A, Deiros C, Garc\u0026iacute;a M, Vendrell M, G\u0026oacute;mez N, G\u0026oacute;mez E, Masdeu J. Comparison between epidural technique and mid-axillary ultrasound-guided TAP block for postoperative analgesia of laparoscopic radical prostatectomy: a quasi-randomized clinical trial. Brazilian J Anesthesiology. 2022;72:253\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDal Moro F, Aiello L, Pavarin P, Zattoni F. Ultrasound-guided transversus abdominis plane block (US-TAPb) for robot-assisted radical prostatectomy: a novel \u0026lsquo;4-point\u0026rsquo;technique\u0026mdash;results of a prospective, randomized study. J robotic Surg. 2019;13:147\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmer DA, Abo Elnasr LM, Ezz HA, Abdullah MA. Pre-emptive analgesic effect of ultrasound-guided quadratus lumborum block versus transversus abdominis plane block in laparoscopic cholecystectomy. Tanta Med J. 2022;50:217\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/tmj_81_20\u003c/span\u003e\u003cspan address=\"10.4103/tmj_81_20\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\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":"prostate cancer, open prostatectomy, transversus abdominis plane block, quadratus lumborum block","lastPublishedDoi":"10.21203/rs.3.rs-3890353/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3890353/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackgroundː Open radical prostatectomy has been found to be related to moderate pain in the early postoperative period. However, postoperative pain, which is not controlled by surgery, can prolong the length of hospital stay. The transversus abdominis plane block technique has been shown to be a safe and effective postoperative analgesic method for urological surgeries. Moreover, it has been reported that a posterior approach involving a Quadratus lumborum block can extend more easily into the thoracic paravertebral space or thoracolumbar plane and provide analgesia from T7 to L1.\u003c/p\u003e \u003cp\u003eMethodsː A total of 62 patients with a mean age of 63.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4 years and a mean body mass index of 24.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 kg/m\u0026sup2; were included in our study. After surgery, the patients were divided into two groups: the first group (Transversus Abdominis Plane) and the second group (Quadratus Lumborum Block) before anaesthesia was terminated.\u003c/p\u003e \u003cp\u003eResultsː The time to postoperative analgesic need, opioid use, opioid dose, and patient satisfaction score were similar for the TAP and QLB block groups. A total of eighteen (29%) patients in both groups needed opioids, for a mean dose of 100 mg.\u003c/p\u003e \u003cp\u003eConclusionsː In conclusion, there was a significant relationship between the opioid dose and the two groups.\u003c/p\u003e","manuscriptTitle":"Comparison of the analgesic efficacy of transversus abdominis plane block and posterior approach quadratus lumborum block after open radical retropubic prostatectomy: a randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-21 18:11:25","doi":"10.21203/rs.3.rs-3890353/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":"bad971aa-3142-48d5-8021-238797d1848f","owner":[],"postedDate":"February 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-11T03:44:36+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-21 18:11:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3890353","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3890353","identity":"rs-3890353","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}