A randomized comparative study of analgesic effect of erector spinae plane block versus quadratus lumborum block for open colorectal cancer surgeries

Background
The erector spinae plane block and quadratus lumborum block can provide analgesia for laparotomy surgeries. This study was conducted to compare their analgesic effects on patients posted for open colorectal cancer resection surgeries. We hypothesized that the erector spinae plane block is superior to the quadratus lumborum block at reducing postoperative pain scores. Therefore, we conducted this study to compare their analgesic efficacy and examine their validity for this type of surgeries.
Patients and methods
76 patients scheduled for open colorectal cancer surgery, aged 40–60 years, either sex, and BMI 18.5–35 Kg/m of ASA physical status I or II were included. All patients were randomized into two groups of 38 patients each. Every patient received 20 ml bupivacaine 0.25% and 4 mg dexamethasone for each side. The numerical rating score for pain, morphine consumption, intensity of postoperative nausea and vomiting, serum cortisol and C- reactive protein, and duration of analgesia were recorded.
Results
The erector spinae plane block provided lower mean pain scores assessed by NRS with statistically significant differences (p < 0.001) during rest and movement, less frequent and easily controlled breakthrough pain than the quadratus lumborum block. There was no difference between the two groups at the time of the first postoperative morphine dose. The mean ± SD values of cumulative morphine consumption after the first and second postoperative 24 hours were 7.24 ± 0.987 and 3.62 ± 0.493, respectively, in the ESPB group, while they were 14.26 ± 2.206 and 7.32 ± 1.007, respectively, in the QLB group. The mean total postoperative nausea and vomiting intensity score was lower in the ESPB group withoutstatistically significant difference. There were no statistically significant differences between the two groups in the mean postoperative serum levels of cortisol and CRP except for CRP after 48 hours, which was 91.25 ± 46.172 in the ESPB group and 53.64 ± 15.324 in the QLB group (p < 0.001).
Conclusion
The erector spinae plane block is an easy and effective opioid sparing analgesic technique. It is recommended to be a part of multimodal analgesia for open colorectal surgeries.