Erector Spinae Plane Block Versus Transmuscular Quadratus Lumborum Block for Postoperative Analgesia in Kidney Transplantation: A Prospective Randomised Controlled Trial

BACKGROUND: Postoperative pain management in kidney transplant recipients is challenging due to altered drug pharmacokinetics and the need to minimize opioid related adverse effects. Ultrasound guided erector spinae plane block (ESPB) and transmuscular quadratus lumborum block (TMQLB) have emerged as effective components of multimodal analgesia; however, comparative data in kidney transplantation are limited. METHODS: In this prospective, single-blind, randomized controlled trial, 63 adult patients undergoing elective living donor kidney transplantation were allocated to ESPB (n = 21), TMQLB (n = 21), or control (n = 21) groups. Patients in the block groups received ultrasound guided ESPB or TMQLB following induction of general anesthesia, while the control group received standard analgesia alone. Postoperative pain intensity was assessed using visual analog scale (VAS) scores during the first 24 h. Total tramadol consumption, time to first analgesic requirement, need for rescue analgesia, adverse effects, and hemodynamic parameters were recorded. RESULTS: Both ESPB and TMQLB groups demonstrated significantly lower VAS scores at all postoperative time points compared with the control group (p < 0.001). Total tramadol consumption was significantly reduced, and the time to first tramadol requirement was significantly prolonged in the block groups versus control (p < 0.001). No significant differences were observed between ESPB and TMQLB with respect to pain scores or total tramadol consumption. Hemodynamic parameters remained stable, and no block related complications were observed. CONCLUSIONS: In kidney transplant recipients, both ESPB and TMQLB provide effective and hemodynamically stable opioid-sparing postoperative analgesia. The comparable efficacy of these techniques allows flexibility in block selection based on patient characteristics and institutional experience.