Comparison of US Bilateral Erector Spinae Plane Block, US Bilateral Quadratus Lumborum Block and Lumbar Epidural for Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy

Arms (3)

1. type

   ACTIVE_COMPARATOR

   label

   bilateral Ultrasound guided erector spinae plane (ESP) block

   description

   . To perform ESP block in the lateral position bilaterally, a linear transducer is placed in a longitudinal parasagittal orientation and erector spinae muscle, trapezius muscle, rhomboid major muscle and transverse process are visualized and local anesthetic is injected (0.25% bupivacaine 20 ml in each side) in the area between transverse process and erector spinae muscle at T10 level.

   interventionNames

   1. Procedure: bilateral Ultrasound guided erector spinae plane (ESP) block

2. type

   ACTIVE_COMPARATOR

   label

   quadratus lumborum block

   description

   In the lateral decubitus position. Right block will be performed; the patient will then repositioned for the left block. An ultrasound device with a convex probe (5-8 MHz) will be placed in the mid-axillary line just above the iliac crest. Then, scan dorsally to keep the transverse orientation until seeing the aponeurosis of the transverses abdominus muscle and by following this aponeurosis, QL muscle will be visualized with its attachment to the lateral edge of the transverse process of the L2 vertebral body and visualize the thoracolumbar fascia at the lateral edge of the QL muscle. A spinal needle (20G) will be inserted in-plane from the anterior to posterior direction, and the tip of the needle will be advanced anterior to the QL muscle. The target site for injection is the plane between the quadratus lumborum and psoas major muscles. This will be followed by injection of 0.25% bupivacaine 20 ml in each side.