Anesthetic management using a combination of anterior quadratus lumborum block and erector spinae plane block for robot-assisted partial nephrectomy: two case reports

Abstract

Background: There has been increasing attention regarding quadratus lumborum block (QLB) and erector spinae plane block (ESPB) as effective truncal blocks. There have been reports of combined QLB and ESPB usage in hip surgery resulting in a symbiotic increase in effectiveness. However, there have been no reports regarding robotassisted partial nephrectomy (RAPN), which requires multiple port holes ranging from near the xiphoid process to below the umbilicus. We hypothesized that the combined use of QLB and ESPB was an option for anesthesia and analgesia during RAPN. Case presentation: Anterior QLB and ESPB were applied to two patients undergoing scheduled RAPN. With intravenous patient-controlled analgesia, the post-surgery numerical rating scale scores were < 3/10 at rest and < 5/10 upon movement, throughout the perioperative time. Conclusions: The combination of QLB and ESPB could be an option for the postoperative analgesia in RAPN.

Effect of ultrasound-guided erector spinae plane block on post-surgical pain in patients undergoing nephrectomy: a single-center, randomized, double-blind, controlled trial

“…There were multiple portholes starting at the xiphoid process and continuing to below the umbilicus, and the NRS score was 5 on movement 48 hours after surgery. 13 Our preliminary results showed that the PACU and the NRS scores from postoperative hours 1 to 24 were lower in the ESP block group than those in the non-ESP block group. Additionally, the total PCA consumption was significantly lower in the ESP block compared with the non-ESP block group.…”

“…There were multiple portholes starting at the xiphoid process and continuing to below the umbilicus, and the NRS score was 5 on movement 48 hours after surgery. 13 …”

“…[9][10][11] In the literature, there are case reports involving both adult and pediatric patients that showed the postoperative analgesic effect of ESP block for nephrectomy, but there have been no clinical trials that evaluated ESP. [12][13][14] Therefore, this study aimed to evaluate the effect of ESP block on postoperative pain in nephrectomy, which leads to both visceral and somatic pain.…”

Current Strategies in Pain Regimens for Robotic Urologic Surgery: A Comprehensive Review

“…Examples include colorectal surgery, C-section, nephrolithotomy, nephrectomy, and gynecological procedures (46)(47)(48). It is also useful in robotic cases where multiple port sites are scattered over various quadrants (49). Because the QL block usually gets T12 -L1 branches, people have also used QL blocks for hip surgeries (50,51).…”

Bloqueos de pared abdominal en nefrectomía parcial asistida por robot

“…Mientras que los resultados de otro ensayo clínico reportan que, en pacientes sometidos a nefrectomía laparoscópica tradicional o asistida por robot, el bloqueo cuadrado lumbar bilateral disminuye el uso de opioides posoperatorios, además de prolongar el tiempo hasta la primera petición de opioides de rescate [23]. Concomitantemente, se ha propuesto sumar al bloqueo de cuadrado lumbar, el bloqueo del músculo erector de la espina, como una alternativa para mejorar la analgesia en el posoperatorio de la nefrectomía parcial asistida por robot; lo que ha demostrado ser útil en un reporte reciente de dos casos [24].…”