Postoperative pain management is a critical factor in enhancing recovery and ambulation
following laparoscopic colorectal surgery. Effective analgesia is necessary to reduce
complications, improve patient comfort, and shorten hospital stays. In this context,
multimodal analgesia is a commonly used strategy that combines various analgesic drugs,
such as paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids, to
manage pain more effectively by targeting different pathways.
Although opioids are considered the gold standard for postoperative pain control, their
use is associated with several undesirable side effects, including nausea, vomiting,
dizziness, constipation, and respiratory depression. These opioid-related complications
can delay recovery, increase patient discomfort, and extend hospital stays. Therefore,
minimizing opioid consumption while still providing effective pain relief is a primary
goal in postoperative pain management, particularly for surgeries such as laparoscopic
colorectal procedures.
To achieve this goal, regional anesthesia techniques have gained increasing popularity.
These techniques, such as interfascial plane blocks, have the potential to reduce opioid
use and improve pain control by targeting specific nerve pathways. One of the more recent
approaches is the quadratus lumborum block (QLB), which involves the injection of local
anesthetics near the quadratus lumborum muscle. This block is particularly useful in
abdominal surgeries because it can provide pain relief by affecting both somatic and
sympathetic nerves, leading to broader and more effective pain coverage.
The QLB has four different approaches: anterior, lateral, posterior, and intramuscular.
The anterior QLB is of particular interest in this setting because it involves the
injection of local anesthetic between the quadratus lumborum and psoas muscles,
potentially allowing the anesthetic to spread into the thoracic paravertebral space. This
spread could result in the blockade of both the somatic nerves and the thoracic
sympathetic chain, offering more comprehensive pain relief that is beneficial for
abdominal surgeries like colorectal procedures.
The potential advantages of the anterior QLB in laparoscopic colorectal surgery include
reduced postoperative pain, decreased opioid consumption, and fewer opioid-related side
effects. Additionally, regional anesthesia techniques like QLB may reduce postoperative
complications, including respiratory issues, which are particularly important in
abdominal surgeries that involve the diaphragm and lower thoracic nerves.
In this study, the hypothesis is that bilateral subcostal anterior QLB, administered
during laparoscopic colorectal surgery, will significantly reduce both postoperative pain
and the need for opioids.
The aim of this study is to investigate the effects of Bilateral subcostal anterior QLB
on postoperative acute pain scores (0-24 hours) and 24- hour opioid consumption in
patients who underwent laparoscopic colorectal surgery. Our study, which the
investigators think will contribute to the literature, was planned as a prospective,
randomized, controlled, parallel-group study.
Patients will be divided into two groups:
Group S-QLB:
A bilateral S-QLB (40 ml 0.25% bupivacaine + 1:400.000 adrenaline) will be performed. In
addition, IV morphine-PCA will be applied postoperatively for 24 hours.
Group Control :
IV morphine-PCA will be applied postoperatively for 24 hours.