Work

Quadratus Lumborum versus Transversus Abdominis Plane Block with Oxycodone or Sufentanil for Recovery Quality After Laparoscopic Gastrointestinal Cancer Surgery: A Factorial Randomized Trial

Year: 2026

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: Purpose: Quadratus lumborum block (QLB) theoretically provides broader visceral analgesia than transversus abdominis plane block (TAPB), while oxycodone, a dual μ- and κ-opioid receptor agonist, may offer superior visceral pain control compared with sufentanil. We evaluated these two regional techniques and two opioid regimens simultaneously in a factorial design to determine their effects on recovery after laparoscopic gastrointestinal cancer surgery. Methods: In this single-center, randomized, 2× 2 factorial trial, 120 adults were randomly assigned to bilateral QLB or TAPB (0.375% ropivacaine 20 mL per side) and oxycodone or sufentanil patient-controlled analgesia. All patients received intraoperative dexmedetomidine and flurbiprofen axetil. The primary outcome was 24-h recovery quality (15-item quality of recovery scale; minimal clinically important difference 6 points). Secondary outcomes included recovery quality at 48 and 72 h, visceral and incisional pain, opioid consumption, rescue analgesia, and adverse events. Results: For 24-h recovery quality, no significant interaction was found between block and opioid ( P = 0.283); QLB vs TAPB (mean [SD] 102.1 [7.9] vs 102.6 [7.6]; mean difference − 0.5, 95% CI − 3.3 to 2.4; P = 0.740) and oxycodone vs sufentanil (103.7 [6.9] vs 100.9 [8.3]; mean difference 2.8, 95% CI 0.1 to 5.6; P = 0.045) did not reach the Bonferroni-corrected threshold ( P < 0.025) or the 6-point difference. Oxycodone was associated with lower visceral pain scores at 1, 6, 24 and 48 h, lower incisional pain scores at 1 and 6 h, and decreased rescue analgesia use (13.3% vs 29.3%). Other outcomes were comparable. Conclusion: Within comprehensive multimodal analgesia, neither QLB nor oxycodone demonstrated superior recovery compared with TAPB or sufentanil. Exploratory findings of lower postoperative pain and less rescue analgesia with oxycodone should be considered hypothesis-generating. Trial Registration: Chinese Clinical Trial Registry (ChiCTR2400080766). Keywords: laparoscopic gastrointestinal surgery, multimodal analgesia, oxycodone, quadratus lumborum block, quality of recovery, sufentanil, transversus abdominis plane block

Source: Drug Design Development and Therapy

DOI: 10.2147/dddt.s641249

Authors: Guo-wang Yang, Xiao-yang Song, Yu-fan Yang, Hong Liu, Fu-hai Ji, Ke Peng