Document Type : Research articles


1 Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China

2 Department of Pain, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China


Background: Both transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) can provide effective analgesia for abdominal surgery.
Objectives: To explore whether there are differences in the effects of TAPB and QLB on the quality of postoperative recovery in patients undergoing laparoscopic radical resection for rectal cancer.
Methods: In total, 102 patients undergoing laparoscopic radical resection for rectal cancer were randomly divided into two groups. Bilateral TAPB or QLB was performed using 0.375% ropivacaine after the induction of anesthesia. The 15-item Quality of Recovery (QoR-15) scale was used to assess the quality of recovery at 24 h postoperatively. Secondary indicators included 24-h postoperative fentanyl consumption, patient-controlled analgesia (PCA), incidence of adverse reactions, numerical rating scale (NRS) at rest and during exercise, and incidence of postoperative complications.
Results: QoR-15 scores were higher in the QLB group than in the TAPB group (115.6±11.3 vs. 99.7±14.2, P<0.05). Moreover, the 24-h sufentanil consumption was less in the QLB group than in the TAPB group (2.4±0.5 vs. 5.5±0.3 ?g, P<0.05) after surgery. Time durations to first postoperative PCA compression were 152.1±28.4 and 100.3 ± 22.9 min, respectively (P<0.05). The numbers of PCA compressions within 24 h after surgery were 6.0 (2.0, 8.0) and 9.0 (3.0, 12.0) (P<0.05). There were no differences in secondary outcomes, such as adverse reactions, NRS scores at rest and exercise at 24 h postoperatively, as well as complication rates.
Conclusion: Patients undergoing laparoscopic radical resection for rectal cancer with QLB had a better quality of recovery and better analgesic effects at 24 h postoperatively, compared to TAPB.


  1. Miller TE, Thacker JK, White WD, Mantyh C, Migaly J, Jin J, et al. Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg. 2014;118(5):1052-61. doi: 10.1213/ANE.0000000000000206. [PMID: 24781574].
  2. Steenhagen E. Enhanced Recovery After Surgery: It's Time to Change Practice!. Nutr Clin Pract. 2016;31(1):18-29. doi: 10.1177/0884533615622640. [PMID: 26703956].
  3. Roulin D, Donadini A, Gander S, Griesser AC, Blanc C, Hubner M, et al. Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery. Br J Surg. 2013;100(8):1108-14. doi: 10.1002/bjs.9184. [PMID: 23754650].
  4. Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24(3):466-77. doi: 10.1016/j.clnu.2005.02.002. [PMID: 15896435].
  5. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):189-98. doi: 10.1097/SLA.0b013e31817f2c1a. [PMID: 18650627].
  6. Kehlet H. Surgical stress: the role of pain and analgesia. Br J Anaesth. 1989;63(2):189-95. doi: 10.1093/bja/63.2.189. [PMID: 2669908].
  7. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003;362(9399):1921-8. doi: 10.1016/S0140-6736(03)14966-5. [PMID: 14667752]. [PMID: 14667752]
  8. Elvir-Lazo OL, White PF. Postoperative pain management after ambulatory surgery: role of multimodal analgesia. Anesthesiol Clin. 2010;28(2):217-24. doi: 10.1016/j.anclin.2010.02.011. [PMID: 20488391].
  9. Chin KJ, McDonnell JG, Carvalho B, Sharkey A, Pawa A, Gadsden J. Essentials of Our Current Understanding: Abdominal Wall Blocks. Reg Anesth Pain Med. 2017;42(2):133-83. doi: 10.1097/AAP.0000000000000545. [PMID: 28085788].
  10. Oh TK, Yim J, Kim J, Eom W, Lee SA, Park SC, et al. Effects of preoperative ultrasound-guided transversus abdominis plane block on pain after laparoscopic surgery for colorectal cancer: a double-blind randomized controlled trial. Surg Endosc. 2017;31(1):127-34. doi: 10.1007/s00464-016-4941-7. [PMID: 27129571].
  11. Kim AJ, Yong RJ, Urman RD. The Role of Transversus Abdominis Plane Blocks in Enhanced Recovery After Surgery Pathways for Open and Laparoscopic Colorectal Surgery. J Laparoendosc Adv Surg Tech A. 2017;27(9):909-14. doi: 10.1089/lap.2017.0337. [PMID: 28742435].
  12. Blanco R, Ansari T, Riad W, Shetty N. Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Pain After Cesarean Delivery: A Randomized Controlled Trial. Reg Anesth Pain Med. 2016;41(6):757-62. doi: 10.1097/AAP.0000000000000495. [PMID: 27755488].
  13. Murouchi T, Iwasaki S, Yamakage M. Quadratus Lumborum Block: Analgesic Effects and Chronological Ropivacaine Concentrations After Laparoscopic Surgery. Reg Anesth Pain Med. 2016;41(2):146-50. doi: 10.1097/AAP.0000000000000349. [PMID: 26735154].
  14. Dam M, Hansen CK, Poulsen TD, Azawi NH, Wolmarans M, Chan V, et al. Transmuscular quadratus lumborum block for percutaneous nephrolithotomy reduces opioid consumption and speeds ambulation and discharge from hospital: a single centre randomised controlled trial. Br J Anaesth. 2019;123(2):e350-8. doi: 10.1016/j.bja.2019.04.054. [PMID: 31153628].
  15. Zhu Q, Li L, Yang Z, Shen J, Zhu R, Wen Y, et al. Ultrasound guided continuous Quadratus Lumborum block hastened recovery in patients undergoing open liver resection: a randomized controlled, open-label trial. Bmc Anesthesiol. 2019;19(1):23. doi: 10.1186/s12871-019-0692-z. [PMID: 30777027].
  16. Blanco R, Ansari T, Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: A randomised controlled trial. Eur J Anaesthesiol. 2015;32(11):812-8. doi: 10.1097/EJA.0000000000000299. [PMID: 26225500].
  17. Srinivas NR. Reduced Ketobemidone Usage in Quadratus Lumborum Block Patients After Cesarean Delivery: Clinical Pharmacology Views. Anesth Analg. 2018;127(1):311. doi: 10.1213/ANE.0000000000003369. [PMID: 29624532].
  18. Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15. Anesthesiology. 2013;118(6):1332-40. doi: 10.1097/ALN.0b013e318289b84b. [PMID: 23411725].
  19. Rao KG, Misra S, Shukla A. Comparison between Epidural Ropivacaine versus Ropivacaine with Clonidine in Patients Undergoing Abdominal Hysterectomy: A Randomized Study. Anesth Essays Res. 2017;11(2):334-9. doi: 10.4103/0259-1162.186601. [PMID: 28663617].
  20. Graf BM, Abraham I, Eberbach N, Kunst G, Stowe DF, Martin E. Differences in cardiotoxicity of bupivacaine and ropivacaine are the result of physicochemical and stereoselective properties. Anesthesiology. 2002;96(6):1427-34. doi: 10.1097/00000542-200206000-00023. [PMID: 12170056].
  21. Li M, Wan L, Mei W, Tian Y. Update on the clinical utility and practical use of ropivacaine in Chinese patients. Drug Des Devel Ther. 2014;8:1269-76. doi: 10.2147/DDDT.S57258. [PMID: 25246768].
  22. Chazapis M, Walker EM, Rooms MA, Kamming D, Moonesinghe SR. Measuring quality of recovery-15 after day case surgery. Br J Anaesth. 2016;116(2):241-8. doi: 10.1093/bja/aev413. [PMID: 26787793].
  23. Kleif J, Gogenur I. Severity classification of the quality of recovery-15 score-An observational study. J Surg Res. 2018;225:101-7. doi: 10.1016/j.jss.2017.12.040. [PMID: 29605019].
  24. Myles PS, Boney O, Botti M, Cyna AM, Gan TJ, Jensen MP, et al. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: patient comfort. Br J Anaesth. 2018;120(4):705-11. doi: 10.1016/j.bja.2017.12.037. [PMID: 29576111].
  25. De Oliveira GJ, Fitzgerald PC, Marcus RJ, Ahmad S, McCarthy RJ. A dose-ranging study of the effect of transversus abdominis block on postoperative quality of recovery and analgesia after outpatient laparoscopy. Anesth Analg. 2011;113(5):1218-25. doi: 10.1213/ANE.0b013e3182303a1a. [PMID: 21926373].
  26. Akerman M, Pejcic N, Velickovic I. A Review of the Quadratus Lumborum Block and ERAS. Front Med (Lausanne). 2018;5:44. doi: 10.3389/fmed.2018.00044. [PMID: 29536008].
  27. Sebbag I, Qasem F, Dhir S. Ultrasound guided quadratus lumborum block for analgesia after cesarean delivery: case series. Rev Bras Anestesiol. 2017;67(4):418-21. doi: 10.1016/j.bjan.2017.03.002. [PMID: 28416174].
  28. Wang D, He Y, Chen X, Lin Y, Liu Y, Yu Z. Ultrasound guided lateral quadratus lumborum block enhanced recovery in patients  undergoing laparoscopic colorectal surgery. Adv Med Sci. 2021;66(1):41-5. doi: 10.1016/j.advms.2020.12.002. [PMID: 33359908].
  29. Kolacz M, Mieszkowski M, Janiak M, Zagorski K, Byszewska B, Weryk-Dysko M, et al. Transversus abdominis plane block versus quadratus lumborum block type 2 for analgesia in renal transplantation: A randomised trial. Eur J Anaesthesiol. 2020;37(9):773-89. doi: 10.1097/EJA.0000000000001193. [PMID: 32175985].
  30. Ishio J, Komasawa N, Kido H, Minami T. Evaluation of ultrasound-guided posterior quadratus lumborum block for postoperative analgesia after laparoscopic gynecologic surgery. J Clin Anesth. 2017;41:1-4. doi: 10.1016/j.jclinane.2017.05.015. [PMID: 28802593].
  31. Aoyama Y, Sakura S, Abe S, Wada M, Saito Y. Analgesic effects and distribution of cutaneous sensory blockade of quadratus lumborum block type 2 and posterior transversus abdominis plane block: an observational comparative study. Korean J Anesthesiol. 2020;73(4):326-33. doi: 10.4097/kja.19404. [PMID: 32008278].