Ultrasound-guided quadratus lumboum block versus transversus abdominis plane block for post-operative analgesia in patients undergoing total abdominal hysterectomy: A systematic review and meta-analysis.

Purpose: Total abdominal hysterectomy is associated with moderate to severe postoperative pain, often requiring multimodal analgesic strategies. This meta-analysis compares the efficacy of ultrasound-guided quadratus lumborum block (QLB) versus transversus abdominis plane (TAP) block for pain control in this setting. Methods: A systematic search was conducted in January 2025 across PubMed, Scopus, and Web of Science, restricted to English-language publications. Study selection and data extraction followed standard protocols and PRISMA guidelines, with screening performed in two phases and study quality rigorously assessed. Outcomes were synthesized using random-effects meta-analysis, and risk of bias was evaluated. Results: Eight randomized controlled trials (RCTs), encompassing 623 patients, met eligibility criteria and were included in the analysis. QLB was associated with significantly lower postoperative pain scores compared to TAP at 12 h (Hedges' g = -4.48; 95 % CI: -8.04 to -0.92; p = 0.01) and 24 h (Hedges' g = -4.16; 95 % CI: -7.56 to -0.77; p = 0.02). No significant differences were observed in duration of analgesia (Hedges' g = 0.64; p = 0.65) or surgery time (Hedges' g = 0.02; p = 0.86). Notable, persistent heterogeneity was present across most outcomes. Subgroup and sensitivity analyses did not identify determinants for this variation, and publication bias assessment by trim-and-fill indicated robust primary findings. However, the review was limited by restriction to selected databases, exclusion of gray literature, and inclusion of English-language studies only. Conclusion: Ultrasound-guided QLB may provide superior analgesia to TAP block following total abdominal hysterectomy. Nonetheless, substantial between-study heterogeneity and database/language restrictions limit the generalizability of these findings. Future large-scale, high-quality trials-incorporating standardized endpoints, broader database searching, non-English studies, and gray literature-are warranted to further clarify the optimal regional analgesic approach post-TAH.