Safety and Efficacy of Ultrasound-Guided Retrolaminar Block of Multiple Injections in Retroperitoneal Laparoscopic Nephrectomy: A Prospective Randomized Controlled Study

Abstract

Purpose Ultrasound-guided retrolaminar block (RLB) has the potential to provide postoperative analgesia in retroperitoneal laparoscopic surgery. This study was conducted to evaluate the effects of RLB when compared with local infiltration analgesia (LIA) in retroperitoneal laparoscopic nephrectomy. Patients and Methods One hundred and fifteen patients scheduled for laparoscopic nephrectomy were divided into two groups: the RLB group (n = 57) received an ultrasound-guided RLB, while the LIA group (n = 58) received LIA. At 2, 4, 6, 24, and 48 hours after operation, the maximal visual analog score (VAS), sufentanil and rescue analgesia consumption, and the utilization of patient-controlled intravenous analgesia (PCIA) were assessed. The incidence rates of postoperative nausea and vomiting (PONV); time of leaving bed (at the first instance); and the levels of plasma β-Endorphin (β-EP), Interleukin-1β (IL-1β), and prostaglandin E2 (PEG2) 30 min after extubation were noted. Results Patients in the RLB group had significantly lower VAS scores; lower sufentanil cumulative consumption; lower manual addition frequency of PCIA; lower proportion of using rescue analgesia within 48 hours after operation; lower incidence rate of PONV; shorter resuscitation times; earlier time of leaving the bed; and lower β-EP, IL-1 β, and PEG2 levels. Conclusion Ultrasound-guided RLB of multiple injections is both safe and controllable for postoperative analgesia after retroperitoneal laparoscopic nephrectomy. When compared with LIA, RLB has better and longer-lasting analgesic effect, lower incidence rates of PONV, and the potential to reduce the level of postoperative inflammatory factors. Trial Registration China Clinical Trials Registration Center ( http://www.chictr.org.cn , No. ChiCTR1800017526, Date of registration: 2018–08-02).

Efficacy of superficial cervical plexus block versus cervical retrolaminar block both combined with auriculotemporal nerve block in parotid surgeries

“…A study investigating RLB for analgesia in rib fractures showed the duration of analgesia to be up to 24 h, with significantly lower VAS from 2 to 24 h using 20 ml of 0.5% ropivacaine [ 8 ]. In laparoscopic retroperitoneal nephrectomy, multiple-level injections at T8, 9, 10 with a total volume of 30 ml of 0.4% ropivacaine, showed the duration of analgesia in RLB to be up to 48 h, though VAS varied significantly from 6 to 48 h [ 9 ].…”

“…Perioperative MBP was significantly lower in Group R up to 12 h . Liu et al [ 9 ] reported that 31.5% of RLB patients with multiple rib fractures required ephedrine.…”

“…The use of ultrasound, reduces the risk of complications [ 5 ]. Until now, there have been insufficient studies on cervical RLB as an analgesic technique for neck surgeries, through it has been shown to provide effective analgesia in breast surgeries [ 6 , 7 ], rib fractures [ 8 ], and abdominal surgeries, such as retroperitoneal nephrectomy [ 9 ].…”

Applications of the ultrasound‐guided nerve block technique for nonanalgesic effects

“…Furthermore, TPVB can significantly improve the mobility of patients following thoracoscopic radical resection of lung cancer, which is beneficial to their rapid recovery after surgery 31 . Additionally, complications, such as bradycardia or hypotension, local anesthetic poisoning, pleural puncture, and pneumothorax from TPVB are very low and worthy of clinical application 39,40 …”

Thoracolumbar retrolaminar block in seven dogs undergoing spinal surgery

“…It is believed that the analgesic action of the block is due to the spread of the local anaesthetic in the paravertebral space where the spinal nerves emerge, and also due to the blockade of the dorsal branch of the spinal nerve as it crosses the epaxial muscles [26], thus providing analgesia for procedures involving the vertebral lamina, the facet joints and epaxial muscles [27]. Clinical studies in humans have presented its analgesic properties in conditions such as mastectomies, rib fractures, and laparoscopies [28][29][30], while a recent case report in human literature has described successful analgesic management of spinal surgery when the retrolaminar block was included in the protocol [31]. This case report describes the utilisation of the thoracolumbar retrolaminar technique as part of a multimodal analgesia protocol in dogs that underwent spinal surgery for thoracolumbar intervertebral disc extrusion.…”