Abstract
BACKGROUND: A critical component of postoperative abdominal surgery recovery is the efficacy of analgesia administered postsurgery. In 2020, a novel approach to the quadratus lumborum block (QLB) was proposed: anterior quadratus lumborum block at the lateral supra-arcuate ligament (QLB-LSAL). A hypothesis indicating that the performance of the block would provide superior analgesia for abdominal surgery was developed. The primary aim of this meta-analysis was to assess the efficacy of the QLB-LSAL in reducing postoperative opioid use. The secondary objective was to assess the effects of this block on postoperative pain-related indicators, including pain scores, time to first patient-controlled analgesia (PCA) activation, and the occurrence of postoperative nausea and vomiting (PONV). METHODS: A comprehensive search of relevant databases, including PubMed, the Cochrane Library, EMBASE, Web of Science, and other relevant sources, was conducted. Studies were screened for broad eligibility by title and abstract, followed by full-text screening. Data were extracted from the included studies and then analyzed via Review Manager software (version 5.4) and STATA (version 18.0 MP-Parallel Edition). RESULTS: A total of eight studies involving 596 participants were included in the analysis. The QLB-LSAL group demonstrated a statistically significant reduction in postoperative opioid consumption within the first 24 h (mean difference [MD] = - 10.88, 95% confidence interval [CI]: - 12.37 to - 9.39, P < 0.00001, I(2) = 0). Additionally, reduced pain scores at rest were observed at various time points postoperatively. The incidence of postoperative nausea and vomiting in the QLB-LSAL group was significantly lower than that in the control group (risk ratio [RR] = 0.47, 95% CI: 0.32 to 0.69, P < 0.0001, I(2) = 41%). Additionally, the QLB-LSAL group exhibited a reduced need for postoperative rescue analgesia (RR = 0.61, 95% CI: 0.39 to 0.96, P = 0.03; I(2) = 0). CONCLUSIONS: The anterior quadratus lumborum block at the lateral supra-arcuate ligament significantly provides less 24-h postoperative opioid consumption after abdominal surgery, prolongs the time to first patient-controlled analgesia activation, and lowers the incidence of postoperative nausea and vomiting. TRIAL REGISTRATION: The protocol of this study was registered with PROSPERO (Registration Number: CRD42024614871).