A randomized controlled trial on analgesic effect of repeated Quadratus Lumborum block versus continuous epidural analgesia following laparoscopic nephrectomy

Abstract

BackgroundEpidural analgesia as the effective pain management for abdominal surgery has side effects such as paresthesia, hypotension, hematomas, and impaired motoric of lower limbs. The quadratus lumborum block (QLB) has potential as an abdominal truncal block, however, its analgesic efficacy has never been compared to epidural analgesia on laparoscopic nephrectomy. This prospective randomized controlled study compared the effectiveness of QLB with the epidural analgesia technique in relieving postoperative pain following transperitoneal laparoscopic nephrectomy.MethodsSixty-two patients underwent laparoscopic donor nephrectomy and were randomized to receive QLB (n = 31) or continuous epidural (n = 31). The QLB group received bilateral QLB using 0.25% bupivacaine and the epidural group received 6 ml/h of 0.25% bupivacaine for intraoperative analgesia. As postoperative analgesia, the QLB group received repeated bilateral QLB with the same dose and the epidural group received 6 ml/h of 0.125% bupivacaine for 24 h after surgery completion. The primary outcome was the 24-h cumulative morphine requirement after surgery. The secondary outcome was the postoperative pain scores. Sensory block coverage, hemodynamic changes, Bromage score, postoperative nausea-vomiting (PONV), paresthesia, and duration of urinary catheter usage were recorded and analyzed.ResultThe 24-h cumulative morphine requirement and pain scores after surgery were comparable between the QLB and epidural groups. The coverage of QLB was extended from T9 to L2 and the continuous epidural block was extended from T8 to L3 dermatomes. The mean arterial pressure (MAP) measured at 24 h after surgery was lower in the epidural group (p = 0.001). Bromage score, incidence of PONV, and paresthesia were not significantly different between the two groups. Duration of urinary catheter usage was shorter (p < 0.001) in the QLB group.ConclusionThe repeated QLB had a similar 24-h cumulative morphine requirement, comparable postoperative pain scores and sensory blockade, higher postoperative MAP, a similar degree of motoric block, no difference in the incidence of PONV and paresthesia, and shorter urinary catheter usage, compared to the continuous epidural analgesia following transperitoneal laparoscopic nephrectomy.Trial registrationClinicalTrial.gov NCT03520205 retrospectively registered on May 9th 2018.

Ultrasound-guided anterior quadratus lumborum block for postoperative pain after laparoscopic pyeloplasty: A randomized controlled trial

“…Epidural catheters and paravertebral blocks (PVBs) have been used for other urological surgeries in adults such as PCNL and LN. [ 6 9 10 ] Each of the above procedures has its own set of complications such as hypotension, urinary retention, PONV, inadvertent motor blockade with epidural analgesia, and risk of vascular puncture, hematoma, pneumothorax, and nerve injuries with PVB. [ 11 ] QLB has been compared with continuous epidural analgesia in patients undergoing LN.…”

“…It was found to have equal analgesic efficacy for a period of 24 hours with higher blood pressures and shorter urinary catheterization time. [ 6 ] QLB was observed to have analgesic efficacy similar to PVB after radical cystectomy, but the study was underpowered to comment on side effects of each procedure. [ 12 ]…”

“…Previous studies have shown that patients receiving QLB had improved analgesia in comparison to controls after urological surgeries such as percutaneous nephrolithotomy (PCNL) and laparoscopic nephrectomy (LN). [ 4 5 6 ] However, the plight of adults undergoing laparoscopic pyeloplasty has remained unaddressed so far. Hence, we decided to compare the efficacy of QLB with the usual practice of infiltration of LA at incision sites in these subsets of patients.…”

Ultrasound-guided Quadratus Lumborum Block for Perioperative Analgesia in Robot-assisted Partial Nephrectomy: A Randomized Controlled Trial

“…Ultrasound-guided QLB technique was first described by Blanco [11,12], and the benefits of QLB for postoperative pain relief and opioids-sparing effect have been reported by several randomized controlled trials and case reports [2,5,6,[8][9][10][19][20][21][22][23][24][25][26][27][28][29][30]. All approaches have been proved the synergistic efficacy for multimode analgesia, especially for QLB2 or QLB3 after laparoscopic surgery, cesarean section and total hip arthroplasty.…”

“…The quadratus lumborum block (QLB) was first described by Blanco in 2007, which later can be subdivided into three basic approaches, known as QLB1, 2, 3 and a modified approach, called intramuscular QLB, based on needle tip position and the spread of local anesthetic (LA) [1]. Recently, an increasing case reports and randomized trials have show that QLB may be effective in postoperative pain relief and opioids-sparing effect after various surgery operations [2][3][4][5][6][7][8][9][10].…”