Efficacy of ultrasound guided quadratus lumborum block as postoperative analgesia in renal transplantation recipients: A randomised double blind clinical study

Abstract

Background and Aims: Postoperative pain following renal transplantation is moderate to severe. Quadratus lumborum block (QLB) is a new block that can provide effective analgesia following abdominal and retroperitoneal surgeries. This study aimed to evaluate the analgesic efficacy of QLB for postoperative analgesia in patients undergoing renal transplantation. Methods: Patients were randomised into two groups of 30 each. In group A (block group), 20 mL of 0.25% bupivacaine and group B (placebo group), 20 mLof normal saline were injected. In the postoperative room, an intravenous patient controlled analgesia (IVPCA) pump with fentanyl was started in both the group. The postoperatively recorded parameters were numerical rating scale (NRS) pain score at rest and on movement and coughing, total fentanyl consumption, sedation score, postoperative nausea vomiting, limb weakness, paralytic ileus, and any other block-related complication. Data were analysed using SPSS software version 22.0. Categorical data were analysed using the Chi-square method. Student t test or Mann–Whitney U test was applied for the continuous data. Numerical data with normal distribution were displayed as mean (standard deviation), abnormal distribution was displayed in the median (interquartile range) values, and as a percentage for categorical variables. Results: Fentanyl consumption, numerical rating score, and sedation score were significantly less in group A when compared to group B at 1, 4, 8, 12, and 24 h ( P < 0.001). Conclusion: Type-1 QLB significantly reduces fentanyl consumption and NRS pain score at 1,4,8,12, and 24 h in the postoperative period in renal transplant recipients.

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“…However, it is a newer technique that many providers are less familiar with, and it is relatively more challenging to perform. A 2020 randomized trial showed that pain scores and opioid usage were reduced in patients who received QL blocks compared to a placebo 48 …”

“…A 2020 randomized trial showed that pain scores and opioid usage were reduced in patients who received QL blocks compared to a placebo. 48 Another 2020 randomized trial comparing single-sided TAP blocks to singlesided QL blocks showed cumulative fentanyl use in the first 24 h was reduced in the QL cohort. Other end-points including pain, patient satisfaction, and adverse opioid effects were no different between the groups.…”

Recent advances in anaesthesia for abdominal solid organ transplantation

“…Postoperative pain management plays a vital role in early recovery and ambulation of transplant recipients. [ 24 ] Standard MMA is not feasible as nonsteroidal anti-inflammatory drugs are contraindicated. Each analgesic option has advantages and disadvantages [ Table 3 ].…”

“…QL block type 1 significantly reduced 24-hour fentanyl consumption and pain scores in renal transplant surgeries. [ 24 ] The most recent is the ESP block [ Figure 1c ] which is a novel technique for perioperative analgesia and can be used in the renal recipient surgery. Following identification and dissection of the plane, a catheter can be inserted to provide continuous analgesia by infusion of 0.2% ropivacaine at 10 ml per hour.…”

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“…In addition to that, the chest wall (pectoralis,[ 15 16 17 ] serratus anterior plane blocks[ 24 25 ]) and abdominal wall[ 26 ] (transversus abdominis,[ 27 28 29 ] quadratus lumborum,[ 30 31 ] rectus sheath blocks) plane blocks are now being routinely performed.…”