Oblique Subcostal Transversus Abdominis Plane Block Versus Transmuscular Quadratus Lumborum Block for Pain Management in Laparoscopic Gynecological Surgery

Oblique Subcostal Transversus Abdominis Plane Block Versus Transmuscular Quadratus Lumborum Block for Pain Management in Laparoscopic Gynecological Surgery

Comparison of The Effect of Oblique Subcostal Transversus Abdominis Plane Block and Transmuscular Quadratus Lumborum Block on Postoperative Analgesia and Quality of Recovery in Patients Undergoing Laparoscopic Gynecological Surgery

Laparoscopic gynecological surgery causes postoperative pain.The primary objective of this study is to compare the effect of ultrasound (US)-guided oblique subcostal transversus abdominis plane block (OSTAP) on 24-hour total analgesic consumption with transmuscular quadratus lumborum block (TQLB).

Patients between the ages of 18-65, who will undergo laparoscopic gynecological surgery, American Society of Anesthesiologists (ASA) class I-II-III, Body Mass Index (BMI) in the range of 18-25 kg/m², and who will use 3 or 4 trocar for surgery will be included in the study. Patients will be randomized into two groups. OSTAP block will be performed for OSTAPB group and TQL block will be performed for TQLB group. Patients will be administered postoperative 4x500 mg iv paracetamol as needed (if Numerical rating scale (NRS) score is 4 or higher). If the NRS score remains at 4 or higher 30 minutes after paracetamol administration, 1 mg/kg iv tramadol will be administered as a rescue analgesic (with a daily maximum dose of 400 mg). The primary outcome is to compare the total analgesic consumption within the first 24 hours after surgery. The secondary outcome is to compare the time to the first postoperative analgesic requirement, NRS scores at rest and on movement, and assess the impact of these two blocks on the quality of recovery using the QOR-15 scale

Postoperative pain, Pain management, Oblique subcostal transversus abdominis plane block, Transmuscular quadratus lumborum block, Quality of Recovery

The investigator will perform oblique subcostal transversus abdominis plane block to that patient group for postoperative analgesia

The investigator will perform transmuscular quadratus lumborum block to that patient group for postoperative analgesia

The investigator will perform oblique subcostal transversus abdominis plane block to that patient group for postoperative analgesia

The investigator will perform transmuscular quadratus lumborum block to that patient group for postoperative analgesia

The primary outcome is to compare the total consumption of paracetamol and tramadol within the first 24 hours after surgery.

The secondary outcome is to compare the time to the first postoperative analgesic requirement, NRS scores at 0, 30th min and 1, 2, 6, 12, 18, 24th hours at rest and on movement, and assess the impact of these two blocks on the quality of recovery using the QoR-15 scale. A numerical rating scale (NRS) requires the patient to rate their pain on a defined scale. For example, 0-10 where 0 is no pain and 10 is the worst pain imaginable. The QoR-15 scale is a unidimensional measurement of quality of recovery measured in five domains: physical comfort, pain, physical independence, psychological support, and emotional state. The QoR-15 scale provides a score ranging from 0 to 150, with a high score indicating a good quality of recovery.

Inclusion Criteria: Ages of 18-65 Patients who will undergo laparoscopic gynecological surgery ASA I-II-III patients Body Mass Index (BMI) in the range of 18-25 kg/m² Patients who will undergo surgery using 3 or 4 trocars Exclusion Criteria: ASA IV-V Patients with a known or suspected allergy to local anesthetics Coagulopathy Injection site infection Severe neurological or psychiatric disorders Severe cardiovascular disease Liver failure Kidney failure (glomerular filtration rate <15 ml/min/m²) Chronic opioid use (>6 months) Surgical durations less than 45 minutes or greater than 120 minutes