Ultrasound-guided quadratus lumborum block for postoperative pain control in patients undergoing unilateral inguinal hernia repair, a comparative study between two approaches.

Ahmed, Abeer; Fawzy, Maher; Nasr, Mohamed; Hussam, Ayman M.; Fouad, Eman; Aboeldahb, Hesham; Saad, Dalia; Osman, Safinaz; Fahmy, Rania Samir; Farid, Mohamed; Waheb, Mohsen M.

doi:10.21203/rs.2.289/v3

Cited by 3 publications

(4 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We also found that posterior QLB significantly prolonged the time to the first opioid requirement. The median time to the first compression of the analgesic pump in the intervention group was significantly longer than in the control group, about 18 h. In the trials of Li et al (12) and Ahmed et al (22), the median time to the first compression of the analgesic pump was 13.5 h and 12 h, respectively. This difference may be related to multimodal analgesia's type or the dose of other analgesics.…”

Section: B Amentioning

confidence: 89%

Ultrasound-guided posterior quadratus lumborum block can reduce postoperative opioid consumption and promote rapid recovery in patients undergoing sutureless laparoscopic partial nephrectomy: A triple-blind, randomized, controlled study

Zhu

Li²,

Qin³

et al. 2022

Front. Oncol.

View full text Add to dashboard Cite

PurposeWe hypothesized that posterior quadratus lumborum block would reduce postoperative opioid consumption and improve the quality of recovery in patients undergoing sutureless laparoscopic partial nephrectomy.Materials and methodsThe study included 60 patients, ages 18−65 with American Society of Anesthesiologists scores of I-II scheduled for elective sutureless laparoscopic partial nephrectomy. Before general anesthesia, 60 participating patients were randomly allocated to receive a 30-ml injection posterior to the quadratus lumborum muscle with either 0.375% ropivacaine (n = 30) or normal saline (n = 30). The primary outcomes included cumulative opioid consumption within 12 h postoperatively and quality of postoperative recovery at 48 h. Secondary outcomes included the Numerical Rating Scale (NRS), opioid consumption by period, first time to press the analgesic pump, number of patients needing rescue analgesia, blood glucose and cortisol concentrations, early postoperative recovery indicators, and adverse events.ResultsThere were 48 patients included in the final analysis. The intervention group had lower cumulative consumption of sufentanil within 12 h postoperatively and higher quality of postoperative recovery scores at 48 h postoperatively compared with the control group (p < 0.001). The NRS at resting and movement of the intervention group was lower at 0 h, 6 h, and 12 h after surgery than in the control group (p < 0.05). At prespecified intervals (0 to 2 h, 2 to 6 h, 6 to 12 h, 12 to 24 h, and 24 to 48 h) after surgery, the intervention group had lower consumption of sufentanil compared with the control group (p < 0.05). The intervention group took longer to press the analgesic pump for the first time within 48 h after surgery compared with the control group (p < 0.001). The postoperative blood glucose and cortisol concentrations in the intervention group were lower than in the control group (p < 0.05). The times to first excretion, ambulation, and discharge were shorter in the intervention group compared with the control group (p < 0.05). There was no significant difference in adverse events between the two groups.ConclusionsOur trial demonstrated that patients who received posterior quadratus lumborum block had significantly lower opioid consumption within 12 h postoperatively and had a better quality of recovery at 48 h postoperatively. Therefore, we recommend posterior quadratus lumborum block as an option for postoperative analgesia in patients undergoing sutureless laparoscopic partial nephrectomy.Trial Registrationhttp://www.chictr.org.cn, identifier ChiCTR2100053439.

show abstract

Section: B Amentioning

confidence: 89%

Ultrasound-guided posterior quadratus lumborum block can reduce postoperative opioid consumption and promote rapid recovery in patients undergoing sutureless laparoscopic partial nephrectomy: A triple-blind, randomized, controlled study

Zhu

Li²,

Qin³

et al. 2022

Front. Oncol.

View full text Add to dashboard Cite

show abstract

“…Previous studies have shown both the TAP block and the anterior QLB to be effective in lowering postoperative pain score and opioid consumption in inguinal repair 4,5 . Ahmed et al 5 found that the anterior QLB significantly lowered postoperative pain scores immediately after arrival in the PACU and after 12 h. A meta‐analysis looking at the duration of a lateral and a posterior TAP showed a reduction of opioid consumption, rest and dynamic pain up to 48 h 16 …”

Section: Discussionmentioning

confidence: 99%

“…Both the TAP block and the anterior Quadratus lumborum (QLB) have been shown to reduce postoperative pain and opioid consumption after laparoscopic inguinal hernia repair 4–6 . The TAP block can be performed using several approaches: subcostal, lateral and posterior 6 .…”

Section: Introductionmentioning

confidence: 99%

Efficacy of a TAP block versus an anterior QLB for laparoscopic inguinal hernia repair: A randomised controlled trial

Sørenstua

Ræder

Vamnes

et al. 2022

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Background: Both the transversus abdominis plane (TAP) block and the anterior quadratus lumborum block (QLB) have been shown effective in reducing postoperative pain after laparoscopic inguinal hernia repair. Our hypothesis was that there is no difference in analgesic effect between the two blocks for this procedure.Methods: In this prospective, double-blind, randomised controlled study, 60 adult patients undergoing laparoscopic inguinal hernia repair were equally randomly assigned to either a preoperative TAP block or an anterior QLB. The primary outcome was oral morphine equivalent (OME) consumption at 4 h postoperatively. Secondary outcomes were OME consumption at 24, 48 h and 7 days, pain scores at rest and when coughing, nausea, and level of sedation measured at 1, 2, 3, 24, and 48 h and 7 days postoperatively.Results: Fifty-three patients completed the study. There was no significant difference in OME consumption at 4 h postoperatively, TAP group (10.3 ± 7.85 mg) (mean ± SD) versus the anterior QLB group (10.9 ± 10.85 mg) (p = .713). The pain scores were similar at rest and when coughing during the 7 day observation period, as were the level of sedation and incidence of nausea. There were no cases of serious side-effects or muscle weakness of the thigh on the same side as the block. Conclusion:There is no difference in OME consumption, pain, nausea or sedation between the TAP and the anterior QLB. Thus, the choice between the two blocks in a clinical setting of laparoscopic inguinal hernia repair should be based on other aspects, such as skills, practicalities, and potential risks.

show abstract

“…The authors reported a longer duration of block in transmuscular QL block group as compared to posterior QL block group (20.1 ± 6.2 versus 12.0 ± 4.8 h, respectively) with a P value of <0.001. Although the authors concluded that total morphine consumption was reduced in the posterior QL group (1.9 ± 0.6 mg versus 1.1 ± 0.9 mg) than in the transmuscular QL group over 24 h,[ 22 ] it does not satisfy aclinically meaningful difference. The present study as compared to that of Ahmed et al .…”

Section: Discussionmentioning

confidence: 99%

To evaluate the effect of quadratus lumborum block on the tramadol sparing effect in patients undergoing open inguinal hernia surgery: A randomised controlled trial

et al. 2020

View full text Add to dashboard Cite

Background and Aims: An ultrasound-guided quadratus lumborum (QL) block provides both somatic and visceral analgesia in abdominal surgeries. We aimed to evaluate the postoperative tramadol sparing effect of single-shot anterior QL block in inguinal hernia surgery patients. Methods: This prospective, randomised controlled trial was conducted in a single tertiary care centre over a period of 1 year. A total of 50 patients, American Society of Anaesthesiologists (ASA) physical status I–II of both sexes aged 18–80 years with body mass index (BMI) ≥20 to ≤35 kg/m 2 undergoing uncomplicated unilateral inguinal hernia surgery under spinal anaesthesia (SA) were randomly allocated to either of the two groups. The block group ( n = 25) received single-shot anterior QL block with 20 ml of 0.5% ropivacaine and the control group ( n = 25) received no block. Postoperatively, patients received intravenous (IV) paracetamol 1g every 6 h and tramadol patient-controlled analgesia up to 24 h. Primary outcome was total tramadol consumption at 24 h postoperatively. Results: The total tramadol consumption mean ± SD [95% CI (range)] at 24 h in the block group was 84.00 ± 37.86 [68.37–99.63 (20–160)] mg versus 93.60 ± 34.99 [79.16–108.04 (20–160)] mg in control group, (p value = 0.36). Postoperative VAS score, haemodynamics, and patient satisfaction score were similar in both the groups. No adverse events were reported. Conclusion: A single-shot anterior QL block did not establish a postoperative tramadol-sparing effect at 24 h as compared to no block in patients undergoing inguinal hernia surgery under SA.

show abstract

Ultrasound-guided quadratus lumborum block for postoperative pain control in patients undergoing unilateral inguinal hernia repair, a comparative study between two approaches.

Cited by 3 publications

References 12 publications

Ultrasound-guided posterior quadratus lumborum block can reduce postoperative opioid consumption and promote rapid recovery in patients undergoing sutureless laparoscopic partial nephrectomy: A triple-blind, randomized, controlled study

Ultrasound-guided posterior quadratus lumborum block can reduce postoperative opioid consumption and promote rapid recovery in patients undergoing sutureless laparoscopic partial nephrectomy: A triple-blind, randomized, controlled study

Efficacy of a TAP block versus an anterior QLB for laparoscopic inguinal hernia repair: A randomised controlled trial

To evaluate the effect of quadratus lumborum block on the tramadol sparing effect in patients undergoing open inguinal hernia surgery: A randomised controlled trial

Contact Info

Product

Resources

About