Abstract: Objective The aim of this study was to compare analgesia by ultrasound-guided superior quadratus lumborum block (QLB) through arcuate ligament or by QLB through anterior approach in patients with gallbladder stones undergoing laparoscopic cholecystectomy (LC). Methods A total of 109 patients with gallbladder stones were encountered in our hospital between January 2023 and December 2024, and all underwent LC. For post-operational analgesia, patients were randomly assigned to receive trans-arcuate ligament superior QLB group (n=51) or trans-anterior approach QLB group (n=58). Analgesia was completed with 0.25% ropivacaine hydrochloride injection for nerve block. The number of block plane segments was evaluated by acupuncture, and pain under rest and when cough was evaluated by visual analogue scale (VAS). Results The postoperative ambulation time in trans-arcuate ligament superior QLB group was (3.8±0.7)h, much earlier than [(4.6±0.9)h, P＜0.05] in trans-anterior approach QLB group, first pressing PCA pump after surgery and remedial analgesia were (5.4±1.1)h and (0.7±0.4)times, much later or less than (4.8±0.9)h and (1.2±0.6)times,P＜0.05] in trans-anterior approach QLB group; onset of analgesia was (6.7±1.6)min, much earlier than [(8.9±2.5)min,P＜0.05] in trans-anterior approach QLB group,and by 5 min, 10 min and 20 min after block, numbers of blocking plane segments were (4.1±0.9), (7.5±1.7) and (8.6±1.8)seg, all much greater than [(2.6±0.5), (5.3±1.1) and (6.8±1.3)seg, respectively, P＜0.05] in trans-anterior approach QLB group;by 6 h, 12 h and 24 h post-operationally, the resting VAS scores were (1.2±0.3), (1.5±0.4) and (1.7±0.7), all much lower than [(1.6±0.5), (1.9±0.8) and (2.0±0.6), P＜0.05], and VAS scores at cough were (1.6±0.6), (2.3±0.7) and (2.1±0.6), all much lower than [(2.2±0.9), (2.8±1.3) and (2.5±1.1),P＜0.05] in trans-anterior approach QLB group. Conclusion Superior QLB through arcuate ligament under ultrasound guidance in patients undergoing LC could effectively improve postoperative analgesic effect, accelerating recovery and reduce the occurrence of adverse reactions.

Key words: Cholelithiasis, Laparoscopic cholecystectomy, Nerve block, Arcuate ligament, Quadratus lumborum, Analgesia