Comparison of three different methods of postoperative analgesic effects in laparoscopic major liver resection (systemic analgesia vs. erector spinae plane block vs. quadratus lumborum block): A randomized controlled trial

This study compared the analgesic effect of single-shot erector spinae plane block (ESPB) or posterior quadratus lumborum block (QLB) versus systemic analgesia alone after laparoscopic major liver resection. This randomized controlled trial was conducted at a single referral center between August 2022 and January 2024. 114 patients undergoing laparoscopic major liver resection were randomized to one of three groups: control, ESPB, or QLB (1:1:1). The control group received systemic analgesia without regional anesthesia, whereas both ESPB and QLB groups received an additional regional anesthesia using 40 mL of 0.5 % ropivacaine. The primary outcome was cumulative opioid consumption within 24 h post-surgery. Secondary outcomes included cumulative opioid consumption, pain intensity, and recovery parameters during 72 h post-surgery. Cumulative opioid consumption (median [IQR]) within 24 h post-surgery was not significantly different among the groups (control, 35 mg [25, 53]; ESPB, 32 mg [21, 44]; QLB, 29 mg [22, 40]; adjP > 0.99). Cumulative opioid consumption at 1 and 48 h also did not significantly differ among the three groups (adjP = 0.336 and 0.732) but was significantly lower at 72 h post-surgery (adjP = 0.032). Pain at rest during the postanesthesia care unit (PACU) stay and at 48 h post-surgery was lower in ESPB and QLB versus control, while pain when coughing in both block groups was reduced only during the PACU stay. Neither ESPB nor posterior QLB resulted in a significant decrease in cumulative opioid consumption within 24 h after laparoscopic major liver resection.