Ultrasound-guided anterior quadratus lumborum block for postoperative pain after percutaneous nephrolithotomy: a randomized controlled trial

Abstract

Background:The quadratus lumborum block (QLB), which is reported to provide analgesia to the abdominal region, is a newly defined fascial plane block method. The present study aimed to investigate the effect of ultrasound guided anterior QLB on the postoperative pain scores after percutaneous nephrolithotomy (PNL). Methods: In this prospective, randomized, controlled single-blind study, 60 patients with PNL operations were randomized into 2 groups. In Group B (n = 30): anterior QLB+ intravenous patient-controlled analgesia (PCA) morphine and in Group C (n = 30): intravenous PCA morphine. Outcome measures were included for visual analog scale (VAS) scores and cumulated consumption for 24 hours postoperatively. Adverse effects, additional analgesic requirement, and intraoperative opioid requirement were recorded. Results: The mean values of the quantity of cumulated morphine used at the 6th, 12th, and 24th hours were found to be statistically significantly lower in Group B (P < 0.05). The VAS scores were found to be statistically significantly lower in Group B (P < 0.05). There were no statistically significant differences in the rate of adverse effects, additional analgesic requirement, and intraoperative opioid requirement between the groups. Conclusions:The study results suggest that anterior QLB is an effective treatment option for postoperative analgesia of PNL.

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

“…Four articles [10,18,26,31] reported the incidence of pruritus within 24 hours after surgery, and no statistical differences were found after analysis (Additional file 2 and Fig.5 ).…”

“…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 .…”

“…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.…”