Discussion
visceral pain, thoracolumbar, somatic pain, inguinal hernia, pain
COMPLICATIONS, UTERUS
In the present study, on the patients who underwent CD under general anesthesia, the total opioid demand in the first 24h was reduced in the anterior QLB group compared to that the TFPB group, but there was no difference in the early (0–9h) opioid requirements. The patients' postoperative resting and dynamic NRS ratings were similar, except for the first hour ratings.There are two components of CD pain. The first is somatic pain from the skin incision, and the second is visceral pain from the exteriorization and straining of the uterus. The anterior branches of the T10–L1 (particularly T12–L1) spinal nerves should be blocked for somatic pain, and the superior/inferior hypogastric plexus branches should be inhibited for visceral pain [TFPB selectively blocks the anterior branches of the T12 and L1 spinal nerves as well as the subcostal, ilioinguinal-iliohypogastric nerves. These nerves carry purely somatic innervations [In the present study, we predicted that anterior QLB would provide visceral analgesia in addition to somatic blockade and would have a better analgesic effect than TFPB, which only provides somatic analgesia. However, contrary to this prediction, the findings of this study revealed that the analgesic activities of both the blocks were comparable. The QL muscle runs in the craniomedial to the caudo-lateral direction as it progresses from the 12th rib to the ilium. The thoracolumbar fascia, latissimus dorsi muscle, lateral raphe, lumbar interfascial triangle, QL, and investing fascia form the lateral part of the paraspinal muscles below L2, while only the transversalis fascia forms the lateral part above L2. This anatomical difference has been reported to allow easy spread of local anesthetics to the posterior of the endothoracic fascia on the transversalis fascia and reach the lower thoracic paravertebral space through anterior QL injections, which are administered at levels higher than the L2 level [A single study comparing these two blocks in lower abdominal surgery for inguinal hernia repair under general anesthesia was found in the literature; the postoperative analgesic activities of both blocks were comparable in this study [In our study, the pain levels were comparable at all measurement times (except for the first hour), and the cumulative morphine requirement was lower in the first 9 h (5.5
[3–8] mg vs. 7 [6–8] mg). We observed that these two blocks had comparable efficacy in the early postoperative hours, when post-surgical pain peaked. The anterior QLB appears to be superior in terms of opioid requirement in the long run (9–24h). However, this difference was small. In the anterior QLB group, the median opioid requirement in the 15h was 2 (IQR, 1–3) mg, and in the TFPB group, it was 3 (IQR, 3–4) mg. Recently, statistical and clinical significance debate has been raised when comparing opioid requirements in studies on fascial plane blocks [Quadriceps weakness, one of the most serious complications of these two blocks, has been reported after anterior QLB and TFPB [CD is usually performed under neuraxial anesthesia in our clinic. Intrathecal morphine for postoperative analgesia is an effective and cost-effective method of analgesia [Our study had the following limitations: first, dermatome examination could not be performed and there was no control group; second, block performance times, including time taken to position, were not recorded, patient ambulation and quadriceps strength were not evaluated.