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Analgesic Outcomes of Ultrasound-Guided QLB vs TAP Block in Midline Laparotomy

ConditionsPostoperative PainMidline LaparotomyAbdominal Surgery
Trial statusNot yet recruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18-65
SponsorSheikh Zayed Medical College

About this trial

This randomized controlled trial compares the analgesic efficacy of ultrasound-guided bilateral lateral quadratus lumborum block (QLB, QL1) versus ultrasound-guided bilateral transversus abdominis plane (TAP) block in adults undergoing elective midline laparotomy under general anesthesia. The primary focus is postoperative pain intensity, time to first rescue analgesia, proportion requiring rescue analgesia, and total opioid consumption in the first 24 hours.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

Age 18-65 years

Either sex

Scheduled for elective midline laparotomy (upper, lower, or full midline incision) under general anesthesia

ASA physical status I-III

Disqualifiers

Body mass index >40 kg/m²

Existing chronic pain disorder, established opioid dependence, or history of substance abuse

Previous or current neurological or psychiatric illness likely to compromise comprehension, decision-making capacity, or reliable reporting of pain scores

Conditions in which an abdominal wall block would not be appropriate or safe (bleeding tendency, ongoing anticoagulation outside acceptable limits, local skin or soft-tissue infection at the planned puncture site, or major distortion of abdominal wall anatomy)

Trial design

Design model

Parallel

Treatments tested in this trial

  • Ultrasound-Guided Lateral Quadratus Lumborum Block (QL1)

    Procedure/Surgery

    After induction of general anesthesia and before surgical incision, under strict aseptic precautions, a low-frequency curvilinear ultrasound transducer is placed between the costal margin and iliac crest. An echogenic 22-gauge 80-100 mm block needle is advanced in-plane toward the anterolateral border of the quadratus lumborum muscle near the junction of the transversus abdominis aponeurosis and transversalis fascia. After hydrodissection and negative aspiration, 20 mL of 0.25% bupivacaine is injected on each side under continuous ultrasound visualization of local anesthetic spread. Total planned volume 40 mL (100 mg bupivacaine), not exceeding 2 mg/kg.

  • Ultrasound-Guided Transversus Abdominis Plane Block

    Procedure/Surgery

    After induction of general anesthesia and before surgical incision, under strict aseptic precautions, a high-frequency linear ultrasound transducer is placed transversely on the anterolateral abdominal wall between the costal margin and iliac crest. The external oblique, internal oblique, and transversus abdominis muscles are identified. An echogenic 22-gauge block needle is advanced in-plane until the tip lies in the fascial plane between the internal oblique and transversus abdominis muscles. After hydrodissection and negative aspiration, 20 mL of 0.25% bupivacaine is injected on each side under continuous ultrasound visualization of local anesthetic spread. Total planned volume 40 mL (100 mg bupivacaine), not exceeding 2 mg/kg.

  • Bupivacaine 0.25%

    Drug

    Local anesthetic used for both QLB and TAP blocks: 20 mL of 0.25% bupivacaine per side (total 40 mL / 100 mg), dose adjusted not to exceed 2 mg/kg body weight.

Treatment groups

100 Participants
are divided into 2 treatment groups
Group A: Group A: Quadratus Lumborum Block (QLB)Experimental treatment 2 interventions
Group B: Group B: Transversus Abdominis Plane Block (TAPB)Active comparator 2 interventions

Trial outcomes

Primary outcomes

1

Postoperative pain intensity at 12 hours

Pain intensity measured using the Numerical Rating Scale (NRS; 0 = no pain, 10 = worst imaginable pain) assessed by an independent blinded outcome assessor.

Time frame
12 hours after completion of surgery

Secondary outcomes

1

Postoperative pain intensity at 6 hours

Pain intensity measured using the Numerical Rating Scale (NRS 0-10) by an independent blinded outcome assessor.

Time frame
6 hours after completion of surgery
2

Postoperative pain intensity at 24 hours

Pain intensity measured using the Numerical Rating Scale (NRS 0-10) by an independent blinded outcome assessor.

Time frame
24 hours after completion of surgery
3

Time to first rescue analgesia

Time (in minutes or hours) from completion of surgery to the first administration of rescue analgesia for NRS score ≥4.

Time frame
From completion of surgery up to 24 hours postoperatively
4

Proportion of participants requiring rescue analgesia within 24 hours

Percentage of participants who receive at least one dose of rescue analgesia (for NRS ≥4) within the first 24 postoperative hours.

Time frame
First 24 hours after surgery

Other outcomes

Sponsors and contacts

Click on the lead sponsor to view all of their trials.

Sheikh Zayed Medical College

Lead sponsor

Source ClinicalTrials.gov

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