Analgesic effect of the ultrasound-guided subcostal approach to transmuscular quadratus lumborum block in patients undergoing laparoscopic nephrectomy: a randomized controlled trial

Abstract

Background Quadratus lumborum block (QLB) is an effective analgesia that lowers opioid consumption after lower abdominal and hip surgeries. The subcostal approach to transmuscular QLB is a novel technique that can provide postoperative analgesia by blocking more dermatomes. The aim of this study is to evaluate the efficacy and viability of subcostal approach to QLB after laparoscopic nephrectomy. Methods Sixty patients who underwent laparoscopic nephrectomy were randomly divided into the subcostal approach to QLB group (QLB group, n = 30) and the control group (C group, n = 30). All patients underwent ultrasound-guided subcostal approach to QLB in an ipsilateral parasagittal oblique plane at the L1–L2 level. The QLB group received 0.4 cc/kg of 0.3% ropivacaine, and the C group received 0.4 cc/kg of 0.9% saline. Postoperatively, a patient-controlled intravenous analgesic pump with sufentanil was attached to all the patients. The primary outcome was sufentanil consumption within the first 24 h after surgery. The secondary outcomes included the Ramsey sedation scale (RSS) scores and Bruggemann comfort scale (BCS) scores 6 h (T1), 12 h (T2), and 24 h (T3) after surgery, intraoperative remifentanil consumption, number of patients requiring rescue analgesia, time to recovery of intestinal function, mobilization time after surgery, and presence of side effects. Results Sufentanil consumption within the first 24 h after surgery was significantly lower in the QLB group than in the C group (mean [standard deviation]: 34.1 [9.9] μg vs 42.1 [11.6] μg, P = .006). The RSS scores did not differ between the two groups, and the BCS scores of the QLB group at T1 and T2 time points was significantly higher than those of the C group( P <0.05). The consumption of remifentanil intraoperatively and the number of patients requiring rescue analgesia were significantly lower in the QLB group ( P <0.05). Time to recovery of intestinal function and mobilization time after surgery were significantly earlier in the QLB group ( P <0.05). The incidence of postoperative nausea and vomiting was significantly lower in the QLB group ( P <0.05). Conclusions The ultrasound-guided subcostal approach to QLB is an effective analgesic technique in patients undergoing laparoscopic nephrectomy as it reduces the consumption of sufentanil postoperatively. Trial registration ChiCTR1800020296 0 (Prospective registered). Initial registration date was 22/12/2018.

Analgesic effectiveness of quadratus lumborum block for patients after abdominal surgery: a systematic review and meta-analysis

“…The two authors(Chao Xu and He Zhu) retrieved a total of 843 articles, 32 of which were viewed in full text 13 articles that met the inclusion criteria and were analyzed for data [10,14,16,18,[23][24][25][26][27][28][29][30][31]. and 380 in the control group.…”

“…Three articles [14,18,29] reported the time interval to the first additional analgesic ,and 5 articles [14,18,23,26,28] reported the numbers of patients who used additional analgesic. No statistical differences were found after subgroup analysis (Additional file 2).…”

“…Eight articles [10,14,16,18,26,28,29,31] reported the incidence of postoperative nausea and vomiting (PONV) within 24 hours. We found that statistical differences only exist in the transmuscular QLB subgroup with an odds ratio of 0.29 (95%CI 0.12 0.70 P=0.005 I 2 =0%) Additional file 2 .…”

“…Three trials[23, 28,29] performed patient satisfaction surveys, but different scales were used( Bruggemann comfort scale (BCS) scores, Quality of Recovery 40 (QoR-40) questionnaire score and obstetric quality-of-recovery scoring tool( ObsQoR -11)), We did not perform data synthesis.…”

“…Studies [8,9] have shown that compared with the transver susabdominisplane block (TAPB), QLB can block both body and visceral pain, with better analgesic effect and longer duration. A number of studies [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] have also reported that the QLB can be an effective postoperative analgesia both for laparoscopic surgery [14,[23][24][25][26][27][28] and cesarean section [10,16,18,[29][30][31], and the choices about the different approaches of QLB were also diverse. However, a meta-analysis of the QLB has not been published.…”