Serpil Şehirlioğlu, Döndü Genç Moralar, Veysel Dinç
Journal of Academic Research in Medicine - 2026;16(1):10-16
Objective: The anterior quadratus lumborum block (aQLB) is commonly used for postoperative pain relief following laparoscopic cholecystectomy (LC). Dexamethasone is known to prolong and enhance analgesia when used as an adjuvant in peripheral nerve blocks. Some studies suggest that systemic administration may be as effective as perineural administration. However, studies directly comparing interfascial administration of dexamethasone in fascial plane blocks with systemic administration remain limited. This study aims to compare the analgesic efficacy and side-effect profiles of interfascial versus systemic administration of dexamethasone with the aQLB. Methods: This retrospective study included 72 patients who underwent elective LC under general anesthesia. All patients received preoperative bilateral aQLBs. Patients were assigned to Group IV (n=33), which received intravenous dexamethasone, or to Group IF (n=39), which received interfascial dexamethasone. The primary endpoint was the time to first rescue analgesic. Secondary endpoints were 24-hour tramadol use, intraoperative remifentanil consumption, numeric rating scale scores at 1,4,8,12, and 24 hours, and side effects. Results: No statistically significant difference was observed between groups in the time to first rescue analgesia; however, median times favored Group IF (5.3 hours vs. 4 hours). The median total tramadol consumption in the first 24 hours was 100 mg [interquartile range (IQR): 150 mg] in Group IV and 75 mg (IQR: 100 mg) in Group IF, with no significant difference between the groups (p=0.256). Numeric rating scale scores and remifentanil use were similar. Nausea was significantly more frequent in Group IF (41%) than in Group IV (18%) (p=0.036). Conclusion: Both systemic and interfascial administration of dexamethasone, when combined with an aQLB in patients undergoing LC, provided comparable postoperative pain relief. However, systemic administration was associated with a lower incidence of postoperative nausea, suggesting it may be preferable for patients at higher risk of this side-effect.
