Transmuscular quadratus lumborum block reduces opioid consumption and prolongs time to first opioid demand after laparoscopic nephrectomy

Abstract

BackgroundRobotic and hand-assisted laparoscopic nephrectomies are often associated with moderate to severe postoperative pain. The aim of the current study was to investigate the analgesic efficacy of the transmuscular quadratus lumborum (TQL) block for patients undergoing robotic or hand-assisted laparoscopic nephrectomy.MethodsFifty patients were included in this single-center study. All patients were scheduled for elective hand-assisted or robotic laparoscopic nephrectomy under general anesthesia. Preoperatively, patients were randomly allocated to TQL block bilaterally with ropivacaine 60 mL 0.375% or 60 mL saline and all patients received standard multimodal analgesia and intravenous patient-controlled analgesia. Primary outcome was postoperative oral morphine equivalent (OME) consumption 0–12 hours. Secondary outcomes were postoperative OME consumption up to 24 hours, pain scores, time to first opioid, nausea/vomiting, time to first ambulation and hospital length of stay (LOS).ResultsMean (95% CI) OME consumption was significantly lower in the intervention group at 12 hours after surgery 50 (28.5 to 71.5) mg versus control 87.5 (62.7 to 112.3) mg, p=0.02. At 24 hours, 69.4 (43.2 to 95.5) mg versus 127 (96.7 to 158.6) mg, p<0.01. Time to first opioid was significantly prolonged in the intervention group median (IQR) 4.4 (2.8–17.6) hours compared with 0.3 (0.1–1.0) hours in the control group, p<0.001. No significant intergroup differences were recorded for time to first ambulation, pain scores, nausea/vomiting nor for LOS.ConclusionPreoperative bilateral TQL block significantly reduced postoperative opioid consumption by 43% and significantly prolonged time to first opioid.Trial registration numberNCT03571490.

Quadratus lumborum Block Reduces Postoperative Opioid Consumption and Decreases Persistent Postoperative Pain Severity in Patients Undergoing Both Open and Laparoscopic Nephrectomies—a Randomized Controlled Trial

“…Second, in our study, the posterolateral QLB was performed postoperatively for both open and laparoscopic nephrectomies. In most other RCTs on this topic, the QLB was performed before laparoscopic nephrectomy[4,5,13], although Aditianingsih et al also performed the QLB postoperatively [12]. Third, in Aditianingsih et al and in a study by Dam et al, the QLB was done bilaterally, while Zhu et al and Kwak et al performed the QLB only on the side of the surgery, as in our study.…”

“…The other outcome measures included pain severity on the VAS at hours 2, 4, 8, 12, and 24; rescue doses of oxycodone administered by nurses in the PACU; patient satisfaction with pain management; and persistent pain evaluation. Satisfaction with pain treatment was assessed on a five-point Likert scale on which the patient and the investigator could describe the pain management as very poor (1), poor (2), moderate (3), good (4), or excellent (5). The presence and intensity of persistent postoperative pain were evaluated during a phone interview at months 1, 3, and 6 using the NPSI [14], which was also used in our previous studies on persistent postoperative pain [15,16].…”

“…Regional anesthesia techniques may improve postoperative pain management and reduce the opioid dosage in the period following renal surgery [2]. Novel blocks have recently been proposed as analgesic options in patients undergoing laparoscopic or open nephrectomy [3][4][5], and such approaches are considered part of multimodal analgesia in the postoperative period [6].…”

“…Quadratus lumborum block (QLB) is a relatively new regional anesthesia technique; it was developed by Blanco [7] and has been proposed as an analgesic alternative for use after many types of surgical procedures [8][9][10]. Several approaches to QLB have been reported [11], but only a few randomized controlled trials (RCT) [4,5,12,13] have evaluated the use of QLB for nephrectomies, all of which concerned laparoscopic procedures. Furthermore, there were differences in the type of block, injection site, and postoperative pain management, and, to our knowledge, none of the RCTs considered QLB following open nephrectomies.…”

“…laparoscopic nephrectomy group than in the CON group (regardless of surgery type), but no difference was found between laparoscopic and open nephrectomies in the QLB group.Our study had some methodological differences from previous RCTs examining QLB use in patients after nephrectomy. First, both open and laparoscopic procedures were studied; in previous RCTs, only laparoscopic nephrectomies were investigated[4,5,12,13]. Second, in our study, the posterolateral QLB was performed postoperatively for both open and laparoscopic nephrectomies.…”