Perioperative Analgesic Efficiency of Ultrasound Guided Quadratus Lumborum Block Versus Epidural Analgesia in Bladder Cancer Patients Undergoing Radical Cystectomy

1. Background and rationale:

Bladder cancer is the ninth most common cancer in the world while being considerably common in both developed and developing countries. Bladder cancer is the most common malignancy among Egyptian males and it had been previously attributed to Schistosoma infection, a major risk factor for squamous cell carcinoma (SCC). Recently, transitional cell carcinoma (TCC) incidence has been increasing while SCC has declined. Exposures to tobacco smoke, occupational toxins, and environmental sources of heavy metals such as arsenic are the major reported risk factors for TCC .

Acute perioperative pain management has been a matter of attention especially in major abdominal surgeries like radical cystectomy. Poor perioperative pain management especially with major abdominal surgeries can lead to deterioration of both physiological and psychological status of the patient leading to anxiety, stress, and patient's dissatisfaction while also leading to severe abdominal pain and diminished respiratory functions due to impaired function of accessory respiratory muscles which may precipitate shallow breathing, atelectasis, retained secretions, and also lack of patient's cooperation.

Adequate multimodal perioperative pain management improves patient's recovery and survival on a general prospective due to decreased surgical stress response leading to better immunological functions and coagulation profile, and hence improving the outcome of the surgery.

Perioperative epidural analgesia has been associated with improved overall survival but not reduced cancer recurrence. However, patients receiving epidural analgesia with or without general anesthesia have shown longer survival over 5 years period postoperatively than those receiving general anesthesia alone which can be related to better immunological profile and decreased stress response in regional anesthesia group of patients.