Efficacy of bilateral anterior approach quadratus lumborum block in patients undergoing laparoscopic cholecystectomy for postoperative analgesia

Despite advances in surgical techniques and anesthesia management, postoperative pain remains an important issue . Pain that develops after surgical intervention is multifactorial, the severity of which varies according to factors including the extent of surgical trauma, anesthesia technique, and the physiological, psychological, emotional, and sociocultural characteristics of the patient . Without timely and effective treatment, acute postoperative pain can turn into persistent chronic postoperative pain .The aim of treating post operative pain is to eliminate or at least reduce pain to a minimum level, to accelerate the healing process and to avoid side effects that can emerge with treatment.In laparoscopic cholecystectomy, overall pain is a conglomerate of three different and clinically separate components: Incisional pain (somatic pain) due to trocar insertion sites, Visceral pain (deep intra-abdominal pain), and Shoulder pain (presumably referred visceral pain) . Inadequate management of postoperative pain can lead to serious consequences, such as poor immediate postoperative effect, prolonged stay and/or hospital readmission, poor patient satisfaction, increased burden on patients and health systems.Multimodal analgesia technique has been widely applied in postoperative analgesia . Truncal block, including transversus abdominis plane block (TAPB), quadratus lumborum block (QLB), rectus sheath block and hernia block, play important roles in multimodal analgesia .The quadratus lumborum block (QLB) is performed as one of the perioperative pain management procedures for all generations (pediatrics, pregnant, and adult) undergoing abdominal surgery . The local anesthetic injected via the approach of the posterior QLB (QLB type-2) can more easily extend beyond the TAP to the thoracic paravertebral space or the thoracolumbar plane, the QLB entails a broader sensory-level analgesic and may generate analgesia from T7 to L1.For laparoscopic cholecystectomy specifically, several randomized trials have investigated anterior (transmuscular) QLB. Some found significantly lower postoperative pain scores and opioid consumption with QLB, while one trial found no difference in analgesic consumption but noted reduced postoperative nausea and vomiting (PONV).These mixed findings highlight the need for further study.Overall, the anterior QLB is an attractive adjunct for laparoscopy: it targets both somatic incisional pain and visceral input via spread to paravertebral nerves and can facilitate earlier mobilization due to its extended analgesic duration.This study aims to check the efficacy of bilateral anterior approach Quadratus lumborum block, in laparoscopic cholecystectomy patient for post operative analgesia.