Ultrasound-guided quadratus lumborum block type 2 associated to continuous intravenous infusion of dexmetomidine for anesthesiologic management in laparoscopic adrenalectomy for pheochromocytoma: could it be a safe strategy?

Luo

et al. 2021

Trials

Background Recently, several case reports and limited randomized studies have shown that quadratus lumborum blocks (QLB) are effective in providing pain relief after intra-abdominal and retroperitoneal operations. Additionally, robot-assisted partial nephrectomy (RAPN) has been proposed as a promising operative treatment for renal carcinoma because it enables early recovery and ambulation. Therefore, we aimed to evaluate the analgesic and opioid-sparing effects of a single-injection QLB in patients undergoing RAPN to determine its role in an early recovery program. Methods Fifty-six patients undergoing elective RAPN under general anesthesia were randomized to two equally sized groups. Patients were randomly allocated to receive either a unilateral QLB (n = 28) with 0.375% bupivacaine 0.5 mL/kg (QLB group) or a conventional scheme (n = 28) (control group). The QLB technique, termed QLB2, was performed as first described by Blanco. The primary outcome was visual analog scale (VAS) scores with movement at 6 h postoperatively. The secondary endpoints were morphine consumption at different time periods after surgery, morphine-related side effects, and assessment of postoperative rehabilitation. Results Both the VAS pain scores and cumulative opioid consumption were significantly lower in the QLB group at 6 h after surgery as compared with results in the control group (all P < 0.05). There were significant differences in pain scores at all time points except at 4 h with movement and 48 h at rest. However, at 12–24 h no significant differences between the two groups were observed in cumulative opioid consumption or in the duration of PACU and hospital stays. The patient recovery scores were significantly higher in the QLB group. Conclusions Single-injection pre-emptive QLB applied to RAPN was effective and provided satisfactory analgesia and opioid-sparing effects in combination with typical patient-controlled analgesia. In addition, it may provide an effective technique for early recovery in the perioperative period for RAPN.

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided quadratus lumborum block for perioperative analgesia in robot-assisted partial nephrectomy: a randomized controlled trial

Luo

et al. 2021

Trials

“…In a patient, 1 μg/kg dexmedetomidine IV resulted in a 49.42% decrease in blood norepinephrine levels ( Singh and Singh, 2014 ). Several case reports in human medicine have consistently described a possible advantage of using dexmedetomidine and overall conclude that it does not totally prevent hemodynamic fluctuations during mass manipulation, but it contributes greatly to intraoperative hemodynamic stability, reducing hypertensive episodes ( Wong and Cheung, 2004 ; Bryskin and Weldon, 2010 ; Schumann and Hudcova, 2010 ; Jung et al ., 2012 ; Khetarpal et al ., 2014 ; Ali Erdogan et al ., 2015 ; Dias et al ., 2015 ; Hedge et al ., 2016 ; Shrestha et al ., 2016 ; Giordano et al ., 2019 ; ). In the veterinary literature, a decrease in vascular resistance following a dexmedetomidine infusion has not been reported.…”

Section: Discussionmentioning

confidence: 99%

“…The TAP block was used to desensitize the abdominal wall ( Skouropoulou et al ., 2018 ; Santos et al ., 2018 ) and has been reported in several adrenalectomies ( Merlin and Veres-Nyéki, 2019 ; Maidanskaia et al ., 2022 ). However, it does not provide visceral analgesia of the abdomen, conversely to other techniques, such as lumbosacral epidural ( Maidanskaia et al ., 2022 ; Merlin and Veres-Nyéki, 2019 ), thoracic epidural ( Viilmann and Vettorato, 2021 ), thoracic paravertebral block ( Merlin and Veres-Nyéki, 2019 ; López-Ramis et al ., 2022 ;), and Quadratus Lumborum Block, which has proven to be efficacious in canine ovariohysterectomies ( Viscasillas et al ., 2021 ) and in a human patient for phaeochromocytoma resection under laparoscopy ( Giordano et al ., 2019 ). The choice for the TAP block was guided by the fact it was routinely performed for laparotomies in our institution.…”

Section: Discussionmentioning

confidence: 99%

“…Its sympatholytic properties ( Gertler et al ., 2001 ) render this agent attractive for the anesthetic management of phaeochromocytoma resection. While its use as an intraoperative constant rate infusion (CRI) has been described in humans ( Wong and Cheung, 2004 ; Bryskin and Weldon, 2010 ; Schumann and Hudcova, 2010 ; Jung et al ., 2012 ; Khetarpal et al ., 2014 ; Ali Erdogan et al ., 2015 ; Dias et al ., 2015 ; Hedge et al ., 2016 ; Shrestha et al ., 2016 ; Giordano et al ., 2019 ; ), concomitant vasodilators were still frequently needed during surgical manipulation. There is, to date, a single case report of its perioperative use for phaeochromocytoma removal in a canine patient ( Viilmann and Vettorato, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Anaesthetic management of a dog undergoing unilateral adrenalectomy for phaeochromocytoma excision using a partial intravenous anaesthetic protocol

Gavet,

Junot

2024

Open Vet J

Background: The anaesthetic management of adrenalectomies for phaeochromocytoma excision, a catecholamine secreting tumour, is challenging due to the potential for fatal complications following severe haemodynamic variations, including hypertensive crisis following tumour manipulation or sympathetic stimulation, but also severe hypotension and volume depletion post resection. Case Description: An 11kg, 15-year-old male neutered Jack Russel Terrier, with mitral valve disease (MVD) stage B2, was referred for adrenalectomy for phaeochromocytoma resection. The patient was administered per os prazosin 0.11mg/kg twice a day and amlodipine 0.125mg/kg once a day for preoperative stabilisation. On the day of surgery, the dog received maropitant 1mg/kg intravenously (IV) and was premedicated with 0.2mg/kg methadone IV. Anaesthesia was induced with alfaxalone 1mg/kg IV and midazolam 0.2mg/kg IV and maintained with a partial intravenous anaesthesia using sevoflurane in 70% oxygen and constant rate infusions of dexmedetomidine 0.5μg/kg/h and maropitant 100μg/kg/h. After induction of anaesthesia, the dog was mechanically ventilated, and a transversus abdominal plane block was performed with ropivacaine 0.2%. The dog remained remarkably stable with a single, self-limiting, hypertension episode recorded intraoperatively. Postoperative rescue analgesia consisted in methadone and ketamine. The dog was discharged 48h after surgery, but persistent hypertension was reported at suture removal. Conclusion: The use of a low dose dexmedetomidine CRI, a maropitant CRI and a TAP block provided stable perioperative haemodynamic conditions for phaeochromocytoma excision in a dog.

“…The quadratus lumborum block (QLB) was first described by Blanco in 2007, which later can be subdivided into three basic approaches, known as QLB1, 2, 3 and a modified approach, called intramuscular QLB, based on needle tip position and the spread of local anesthetic (LA) [1]. Recently, an increasing case reports and randomized trials have show that QLB may be effective in postoperative pain relief and opioids-sparing effect after various surgery operations [2][3][4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided Quadratus Lumborum Block for Perioperative Analgesia in Robot-assisted Partial Nephrectomy: A Randomized Controlled Trial

Luo

Liu

et al. 2020

Preprint

Background Recently, several case reports and limited randomized studies have shown that the quadratus lumborum block (QLB) is effective in providing pain relief after intra-abdominal and retroperitoneal operations. Robot-assisted partial nephrectomy (RAPN) has also been proposed as a promising operative treatment for renal carcinoma because it enables early recovery and ambulation. Therefore, we aimed to evaluate the analgesic and opioid-sparing effects of a single-injection QLB, which may paly an important role on early recovery program in RAPN.MethodsFifty-six patients undergoing elective RAPN under general anesthesia were randomised to two equally sized groups. Patients were randomly allocated to receive unilateral QLB (n=28) with 0.375% bupivacaine 0.5 mL/kg (QLB group) or a conventional scheme (n=28) group (Control group). The QLB technique was performed as first described by Blanco, termed QLB2. The primary outcome was the visual analogue scale (VAS) scores with movement at 6 hours postoperatively. The secondary endpoints were the morphine consumption at different time-period after surgery, morphine-related side effects and assessment of postoperative rehabilitation. ResultsBoth VAS pain score and cumulative opioid consumption were significantly lower in the QLB group at 6 hours after surgery as compared with the control group (all P<0.05). There was significant difference in pain scores at any other time-point except at 4 hours on movement and 48 hours at rest. However, no significant difference was observed in 12-48 hours cumulative opioid consumption, and in the duration of PACU and hospital stay between the two groups. The patient recovery scores was significantly higher in the QLB group.ConclusionsSingle-injection pre-emptive QLB applied to RAPN was effective and provided satisfactory analgesia and opioids-sparing in combination with a typical patient-controlled analgesia. In addition, it may provide an effective technique for early recovery in perioperative period.