• Wen-Quan He, Yu-Jie Li, Yong-Shuai Li, Xu-Hao Zhang, Jian Cao, Kai-Zhi Lu, Chi Wai Cheung, Jian-Teng Gu, Zheng-Yuan Xia, and Bin Yi.
• Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing.
• Clin J Pain. 2022 Dec 1; 38 (12): 730738730-738.

ObjectiveWe aimed to compare the analgesic effect and incidence of lower limb weakness of transmuscular quadratus lumborum (TQL) block via subfascial approach with that via extrafascial after laparoscopic cholecystectomy (LC).MethodsEighty patients undergoing LC were randomized to receive ultrasound-guided bilateral TQL block via subfascial (subfascial group) or extrafascial (extrafascial group) using 30 mL of 0.33% ropivacaine unilaterally. Pain scores of port sites while rest and coughing at 1, 6, 12, 24, 36, and 48 hours postoperatively as primary outcome were compared. Modified Lovett Rating Scale, ambulatory dependency, and rescue analgesia requirement was also compared.ResultsThe pain score of the subxiphoid and of the right subcostal port site for up to the postoperative 36 hours (2 [1 to 2]) and 24 hours (2 [2 to 3]) in the subfascial group was significantly lower than that in extrafascial group (2 [2 to 2] and 3 [2.25 to 4]). Up to postoperative 24 hours, the rescue analgesia requirement in subfascial group was significantly lower than that in extrafascial group, namely less fentanyl consumption and parecoxib (1.3 [±5.5] μg vs. 5.6 [±10.6] μg; 17.5% vs. 37.5%). The ratio of patients with LRS score of 6 at postoperative 1 hour (65.0%), and with dependent ambulation at postoperative 1 and 6 hours in subfascial group (15.0% and 0.0%) was significantly lower than that in extrafascial group (10.0%, 80.0%, and 17.5%).ConclusionTQL block via subfascial had the advantages of better analgesic effect and less lower limbs weakness after LC over that via extrafascial.Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

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