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Hui M, Mohr-Sasson A, Hernandez N, Bhalwal A, Montealegre A, Dziadek O, Leon M, Ghorayeb T, Pedroza C, Santos RB, Jalloul R. Effect of Preoperative Bilateral Ultrasound-Guided Quadratus Lumborum Nerve Block on Quality of Recovery After Minimally Invasive Hysterectomy in an Enhanced Recovery After Surgery (ERAS) Setting. J Minim Invasive Gynecol 2024; 31:769-777. [PMID: 38797277 DOI: 10.1016/j.jmig.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/16/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
STUDY OBJECTIVE To assess the effect of preoperative bilateral ultrasound-guided quadratus lumborum nerve block (QLB) on quality of recovery after minimally invasive hysterectomy, in an enhanced recovery after surgery setting. DESIGN Randomized, controlled, double-blinded trial (Canadian Task Force level I). SETTING University-affiliated tertiary medical center. PATIENTS All women undergoing an elective robotic or laparoscopic hysterectomy. Women with chronic pain, chronic anticoagulation, and body mass index >50 kg/m2 were excluded. INTERVENTION Patients were randomized with a 1:1 allocation, to one of the following 2 arms, and stratified based on robotic versus laparoscopic approach. 1. QLB: QLB (bupivacaine) + sham local trocar sites infiltration (normal saline) 2. Local infiltration: sham QLB (normal saline) + local infiltration (bupivacaine) MEASUREMENTS AND MAIN RESULTS: The primary outcome was defined as the quality of recovery score based on the validated questionnaire Quality of Recovery, completed 24 hours postoperatively. Secondary outcomes included dynamic pain scores, accumulated opioid consumption up to 24 hours, postoperative nausea and vomiting, surgical complications, length of hospital stay, time to first pain medication administration in the postanesthesia care unit, and adverse events. A total of 76 women were included in the study. Demographic characteristics were similar in both groups. Median age was 44 years (interquartile range 39-50), 47% of the participants were African American, and mean body mass index was 32.8 kg/m2 (standard deviation [SD] 8.1). The mean Quality of Recovery score was 179.1 (SD ± 10.3) in the QLB and 175.6 (SD ± 9.7) for the local anesthesia group (p = .072). All secondary outcomes were comparable between groups. CONCLUSIONS QLBs do not significantly improve quality of recovery after elective robotic or laparoscopic hysterectomy compared with local anesthetic port site infiltration.
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Affiliation(s)
- Mason Hui
- Department of Obstetrics, Gynecology, and Reproductive Sciences - Division of Minimally Invasive Gynecologic Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas (Drs. Hui, Mohr-Sasson, Bhalwal, Montealegre, Dziadek, Leon, Ghorayeb, Pedroza, Santos)
| | - Aya Mohr-Sasson
- Department of Obstetrics, Gynecology, and Reproductive Sciences - Division of Minimally Invasive Gynecologic Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas (Drs. Hui, Mohr-Sasson, Bhalwal, Montealegre, Dziadek, Leon, Ghorayeb, Pedroza, Santos)
| | - Nadia Hernandez
- Department of Anesthesiology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas (Dr. Hernandez)
| | - Asha Bhalwal
- Department of Obstetrics, Gynecology, and Reproductive Sciences - Division of Minimally Invasive Gynecologic Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas (Drs. Hui, Mohr-Sasson, Bhalwal, Montealegre, Dziadek, Leon, Ghorayeb, Pedroza, Santos)
| | - Alvaro Montealegre
- Department of Obstetrics, Gynecology, and Reproductive Sciences - Division of Minimally Invasive Gynecologic Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas (Drs. Hui, Mohr-Sasson, Bhalwal, Montealegre, Dziadek, Leon, Ghorayeb, Pedroza, Santos)
| | - Olivia Dziadek
- Department of Obstetrics, Gynecology, and Reproductive Sciences - Division of Minimally Invasive Gynecologic Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas (Drs. Hui, Mohr-Sasson, Bhalwal, Montealegre, Dziadek, Leon, Ghorayeb, Pedroza, Santos)
| | - Mateo Leon
- Department of Obstetrics, Gynecology, and Reproductive Sciences - Division of Minimally Invasive Gynecologic Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas (Drs. Hui, Mohr-Sasson, Bhalwal, Montealegre, Dziadek, Leon, Ghorayeb, Pedroza, Santos)
| | - Tala Ghorayeb
- Department of Obstetrics, Gynecology, and Reproductive Sciences - Division of Minimally Invasive Gynecologic Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas (Drs. Hui, Mohr-Sasson, Bhalwal, Montealegre, Dziadek, Leon, Ghorayeb, Pedroza, Santos)
| | - Claudia Pedroza
- Department of Obstetrics, Gynecology, and Reproductive Sciences - Division of Minimally Invasive Gynecologic Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas (Drs. Hui, Mohr-Sasson, Bhalwal, Montealegre, Dziadek, Leon, Ghorayeb, Pedroza, Santos)
| | - Rafael Bravo Santos
- Department of Obstetrics, Gynecology, and Reproductive Sciences - Division of Minimally Invasive Gynecologic Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas (Drs. Hui, Mohr-Sasson, Bhalwal, Montealegre, Dziadek, Leon, Ghorayeb, Pedroza, Santos)
| | - Randa Jalloul
- Department of Obstetrics, Gynecology, and Reproductive Sciences - Division of Minimally Invasive Gynecologic Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas (Drs. Hui, Mohr-Sasson, Bhalwal, Montealegre, Dziadek, Leon, Ghorayeb, Pedroza, Santos).
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Gao T, Wang Y, Zheng Y, Yu Y, Li Q, Zhang L. Quadratus lumborum block vs. transversus abdominis plane block for postoperative pain control in patients with nephrectomy: A systematic review and network meta-analysis. J Clin Anesth 2024; 95:111453. [PMID: 38531283 DOI: 10.1016/j.jclinane.2024.111453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/04/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024]
Abstract
STUDY OBJECTIVE This systematic review and network meta-analysis aimed to compare the analgesic efficacy of transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) on nephrectomy. DESIGN Systematic review and network meta-analysis. PATIENTS Patients undergoing nephrectomy. INTERVENTIONS TAPB and QLB for postoperative analgesia. MEASUREMENTS The primary outcome was 24 h morphine-equivalent consumptions after surgery. Secondary outcomes included postoperative pain scores, postoperative opioid consumption, postoperative rescue analgesia, postoperative nausea and vomiting (PONV), length of hospital stay after surgery, and patient satisfaction. MAIN RESULTS Fourteen studies involving 883 patients were included. Seven studies compared TAPB to control, six studies compared QLB to control, and one study compared TAPB to QLB. For direct meta-analysis of the post-surgical 24 h morphine-equivalent consumption, QLB was lower than control (mean difference [95%CI]: -18.16 [-28.96, -7.37]; I2 = 88%; p = 0.001), while there was no difference between TAPB and control (mean difference [95%CI]: -8.34 [-17.84, 1.17]; I2 = 88%; p = 0.09). Network meta-analysis showed similar findings that QLB was ranked as the best anesthetic technique for reducing postoperative 24 h opioid consumption (p-score = 0.854). Moreover, in direct meta-analysis, as compared to control, the time of first postoperative rescue analgesia was prolonged after QLB (mean difference [95%CI]: 165.00 [128.99, 201.01]; p < 0.00001), but not TAPB (mean difference [95%CI]: 296.82 [-91.92, 685.55]; p = 0.13). Meanwhile, QLB can effectively reduce opioid usages at intraoperative period, as well as at postoperative 6 h and 48 h, while TAPB can only reduce opioid consumption at 6 h after surgery. As compared to control, both TAPB and QLB exhibited the reduction in PONV and pain scores at post-surgical some timepoints. Also, QLB (mean difference [95%CI]: -0.29 [-0.49, -0.08]; p = 0.006) but not TAPB (mean difference [95%CI]: 0.60 [-0.25, 1.45]; p = 0.17) exhibited the shorter postoperative length of hospital stay than control. CONCLUSIONS QLB is more likely to be effective in reducing postoperative opioid use than TAPB, whereas both of them are superior to control with regard to the reduction in postoperative pain intensity and PONV. TRIAL REGISTRATION PROSPERO identifier: CRD42022358464.
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Affiliation(s)
- Tianyu Gao
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin 300052, China
| | - Yigang Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin 300052, China
| | - Yuxin Zheng
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin 300052, China
| | - Yonghao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin 300052, China
| | - Qing Li
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin 300052, China.
| | - Linlin Zhang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Research Institute of Anesthesiology, Tianjin 300052, China.
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Mattaliano G, Verdier N, Klonner ME, Kyllar M, Kau-Strebinger S, Otero PE. Ultrasound-guided quadratus lumborum block in sheep: A cadaveric study. Lab Anim 2024:236772241246021. [PMID: 39075854 DOI: 10.1177/00236772241246021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
This prospective anatomical study aimed to establish an ultrasound-guided technique to the quadratus lumborum (QL) plane in sheep cadavers. Thirteen cadavers, weighing less than 117 kg, were included. In phase 1, one cadaver underwent dissection and two cadavers underwent 3D computed tomographic reconstruction for anatomical evaluation of the thoracolumbar region. In phase 2, two cadavers were used to compare two ultrasound techniques to the QL plane: lateral to the QL muscle with a transversal approach (LQL) and transmuscular between QL and psoas muscles with a longitudinal approach (TQL). For LQL, the reference was the first lumbar transverse process, whereas for TQL, it was the intertransverse region between the first and second lumbar vertebrae. The needle was advanced in-plane towards the specific target for each technique and a total of four injections were performed using 0.4 ml kg-1 of a dye-lidocaine solution. In phase 3, 10 cadavers received bilateral LQL injections (n = 20). All cadavers were then dissected to evaluate spread of dye. In phase 2, following LQL injections, no dye was observed in undesired locations; however, the dye was noted in the retroperitoneal space (1/2) after TQL injections. In phase 3, the 13th thoracic, first, second, third lumbar nerves, and sympathetic trunk segments were stained in 80%, 95%, 100%, 45% and 35% of the injections, respectively. In conclusion, the LQL technique was feasible, allowing staining of the spinal nerves innervating the cranial abdomen in sheep cadavers. Further studies in live animals are warranted.
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Affiliation(s)
- Giorgio Mattaliano
- Clinical Unit of Anaesthesiology and Perioperative Intensive-Care Medicine, Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Austria
| | - Natali Verdier
- Clinical Unit of Anaesthesiology and Perioperative Intensive-Care Medicine, Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Austria
| | | | - Michal Kyllar
- Institute of Morphology, Department of Pathobiology, University of Veterinary Medicine Vienna, Austria
| | - Silvio Kau-Strebinger
- Institute of Morphology, Department of Pathobiology, University of Veterinary Medicine Vienna, Austria
| | - Pablo E Otero
- Department of Anaesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Argentina
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Theeraratvarasin C, Jirativanon T, Taweemonkongsap T, Liangkobkit K, Aussavavirojekul P, Jitpraphai S, Chotikawanich E, Woranisarakul V, Hansomwong T. Anterior quadratus lumborum block provided superior pain control and reduced opioid consumption in kidney transplantation: A randomized controlled trial. Medicine (Baltimore) 2024; 103:e38887. [PMID: 38996130 PMCID: PMC11245234 DOI: 10.1097/md.0000000000038887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND The research aimed to assess the effectiveness of inside-out anterior quadratus lumborum (QL3) block and local wound infiltration in managing postoperative pain and total morphine dosage following kidney transplantation. METHODS In this prospective, randomized, double-blind study; 46 end-stage renal disease patients undergoing kidney transplantation were randomly allocated into 2 groups: a QL group (n = 23) receiving 20 mL of 0.25% bupivacaine using the ultrasound-assisted inside-out technique before wound closure, while the local wound infiltration (LA) group (n = 23) receiving the same dose around the surgical wound and drain at the time of skin closure. The primary outcome measure was the numerical pain rating scale, with secondary outcomes including amount of morphine consumption at various postoperative time points (2nd, 4th, 6th, 12th, 18th and 24th hours). RESULTS Patients in the QL group had significantly lower numerical rating scale scores at the 2nd and 4th hours, both at rest and during movement (P < .05). Although pain scores at rest and during movement at later time points were lower in the QL group compared to the LA group, these differences were not statistically significant. Cumulative morphine consumption at postoperative 4th, 6th, 12th, 18th and 24th hours was significantly lower in the QL group (P < .05). No patients experienced complications from the QL3 block. CONCLUSION Ultrasound-assisted inside-out QL3 block significantly reduced postoperative pain levels at the 2nd and 4th hours, both at rest and during movement, and led to a reduction in cumulative morphine consumption from the 4th hour postoperatively, and persisting throughout the 24-hour period.
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Affiliation(s)
- Cheevathun Theeraratvarasin
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tachawan Jirativanon
- Department of Anesthesia, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tawatchai Taweemonkongsap
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Karn Liangkobkit
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pubordee Aussavavirojekul
- Division of Informatics Imaging and Data Sciences, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Siros Jitpraphai
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekkarin Chotikawanich
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varat Woranisarakul
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thitipat Hansomwong
- Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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El Malla DA, El Mourad MB. Ultrasound-guided quadratus lumborum block: Posterior versus anterior approach in paediatrics undergoing laparoscopic inguinal hernia repair. J Anaesthesiol Clin Pharmacol 2024; 40:293-298. [PMID: 38919434 PMCID: PMC11196054 DOI: 10.4103/joacp.joacp_366_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/29/2022] [Accepted: 11/07/2022] [Indexed: 06/27/2024] Open
Abstract
Background and Aims Regional anaesthesia has gained popularity in managing post-operative pain in paediatric patients. Quadratus lumborum block (QLB) is recognised as one of the peri-operative pain management techniques used during abdominal surgeries. However, no consensus about the best approach has been reached. Material and Methods Sixty paediatric patients with ages ranging from 1 to 6 as well as classification I and II of the American Society of Anesthesiologists, scheduled for laparoscopic inguinal hernia, were allocated to receive either a posterior approach (Group I) or an anterior approach (Group II) QLB. Twenty four-hour morphine consumption, the face, legs, activity, cry, and consolability (FLACC) score, duration of analgesia, performance time, and block-related complications were recorded. Results Group II showed significantly lower morphine consumption as well as a longer duration of analgesia (P = 0.039*, 0.020*, respectively), with an equivalent period for block performance being reported in the two groups (P = 0.080). At 2, 4, 6, and 12 hours post-operatively, the FLACC scores were substantially diminished in Group II compared to Group I (P = 0.001*, 0.012*, 0.002*, 0.028*, respectively). However, at twenty-four hours, comparable pain scores were observed between both groups (P = 0.626). In addition, there were no block-related complications. Conclusions In paediatric patients scheduled for laparoscopic inguinal hernia repair, the ultra-sound-guided anterior approach of the QLB was associated with significantly reduced post-operative morphine consumption, a lower FLACC score, and a longer analgesia duration when compared to the posterior approach.
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Affiliation(s)
- Dina A. El Malla
- Department of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mona B. El Mourad
- Department of Anesthesia, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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Mahmoud Fakhry D, ElMoutaz Mahmoud H, Yehia Kassim D, NegmEldeen AbdElAzeem H. Erector Spinae Plane Block versus Quadratus Lumborum Block for Postoperative Analgesia after Laparoscopic Resection of Colorectal Cancer: A Prospective Randomized Study. Anesthesiol Res Pract 2024; 2024:6200915. [PMID: 38529324 PMCID: PMC10963107 DOI: 10.1155/2024/6200915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 03/27/2024] Open
Abstract
Background In recent years, the attention paid to colorectal cancer (CRC) surgery and postoperative analgesia has increased. Objective The objective of the current study was to compare the impact of ultrasound-guided erector spinae plane block (ESPB) and transmuscular quadratus lumborum block (TQLB) upon providing relief to patients with postoperative pain who underwent laparoscopic resection for CRC. Methods In this prospective, comparative, and randomized study, the authors considered a total of 60 patients who chose to undergo laparoscopic resection for colorectal cancer. The total number of patients was randomly divided into two groups (such as ESPB and TQLB) so that each group had a total of 30 patients. For the former group, i.e., the ESPB group, 20 ml of 0.25% bupivacaine was administered at each side for bilateral ultrasound-guided erector spinae plane block, while the latter group received the same dose of medicine for bilateral ultrasound-guided transmuscular quadratus lumborum block (TQLB). The researchers recorded the first time to rescue an analgesic, the whole amount of rescue analgesia under consumption in the first 24 hours after the surgical procedure, and associated adverse events. Results Among the groups considered, the ESPB group took a significantly lengthy time to raise a first request for rescue analgesic (280 ± 15.5 min) in comparison with the TQLB group (260 ± 13.8 min). Likewise, the consumption of overall nalbuphine was remarkably lesser in the ESPB group during the first 24 hours (24 ± 2.5 mg) compared to the TQLB group (30.5 ± 1.55 mg). Conclusion The analgesic efficacy of ESPB was better when compared to TQLB in terms of time to rescue analgesia and overall opioid consumption during the first 24 hours. This study was registered at ClinicalTrials.gov on 10/10/2022 (registration number: NCT05574283).
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Affiliation(s)
- Dina Mahmoud Fakhry
- Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Hatem ElMoutaz Mahmoud
- Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Dina Yehia Kassim
- Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Hebatallah NegmEldeen AbdElAzeem
- Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Hu J, Li X, Wang Q, Yang J. Minimum effective concentration of ropivacaine for ultrasound-guided transmuscular quadratus lumborum block in total hip arthroplasty: a randomized clinical trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:744461. [PMID: 37657517 DOI: 10.1016/j.bjane.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE This trial aimed to identify the Minimum Effective Concentration (MEC90, defined as the concentration which can provide successful block in 90% of patients) of 30 mL ropivacaine for single-shot ultrasound-guided transmuscular Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA). METHODS A double-blind, randomized dose-finding study using the biased coin design up-and-down sequential method, where the concentration of local anesthetic administered to each patient depended on the response from the previous one. Block success was defined as a Numeric Rating Scale (NRS) score during motion ≤ 3 at 6 hours after arrival in the ward. If the block was successful, the next subject received either a 0.025% smaller dose (probability of 0.11) or the same dose (probability of 0.89); otherwise, the next subject received a 0.025% higher ropivacaine concentration. MEC90, MEC95 and MEC99 were estimated by isotonic regression, and the corresponding 95% Confidence Intervals (95% CIs) were calculated by the bootstrapping method. RESULTS Based on the analysis of 52 patients, MEC90, MEC95, and MEC99 of ropivacaine for QLB were estimated to be 0.352% (95% CI 0.334-0.372%), 0.363% (95% CI 0.351-0.383%), and 0.373% (95% CI 0.363-0.386%). The concentration of ropivacaine at 0.352% in a volume of 30 ml can provide a successful block in 90% of patients. CONCLUSIONS For ultrasound-guided transmuscular QLB in patients undergoing THA, 0.352% ropivacaine in a volume of 30 ml can provide a successful block in 90% of patients. Further dose-finding studies and large sample size are required to verify the concentration.
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Affiliation(s)
- Jian Hu
- Sichuan University, West China Hospital, Department of Anesthesiology, Chengdu, China
| | - Xingcheng Li
- Sichuan University, West China School of Nursing, West China Tianfu Hospital, Department of Urology, Chengdu, China
| | - Qiuru Wang
- Sichuan University, West China Hospital, Department of Orthopedic Surgery, Chengdu, China
| | - Jing Yang
- Sichuan University, West China Hospital, Department of Anesthesiology, Chengdu, China.
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Dai J, Li S, Weng Q, Long J, Wu D. Opioid-free anesthesia with ultrasound-guided quadratus lumborum block in the supine position for lower abdominal or pelvic surgery: a randomized controlled trial. Sci Rep 2024; 14:4652. [PMID: 38409359 PMCID: PMC10897418 DOI: 10.1038/s41598-024-55370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/22/2024] [Indexed: 02/28/2024] Open
Abstract
In the past, quadratus lumborum block (QLB) was mostly used for postoperative analgesia in patients, and few anesthesiologists applied it during surgery with opioid-free anesthesia (OFA). Consequently, it is still unclear whether QLB in the supine position can provide perfect analgesia and inhibit anesthetic stress during surgery under the OFA strategy. To observe the clinical efficacy of ultrasound-guided quadratus lumborum block (US-QLB) in the supine position with OFA for lower abdominal and pelvic surgery. A total of 122 patients who underwent lower abdominal or pelvic surgery in People's Hospital of Wanning between March 2021 and July 2022 were selected and divided into a quadratus lumborum block group (Q) (n = 62) and control group (C) (n = 60) according to the random number table method. Both groups underwent general anesthesia combined with QLB in the supine position. After sedation, unilateral or bilateral QLB was performed via the ultrasound guided anterior approach based on images resembling a "human eye" and "baby in a cradle" under local anesthesia according to the needs of the operative field. In group Q, 20 ml of 0.50% lidocaine and 0.20% ropivacaine diluted in normal saline (NS) were injected into each side. In group C, 20 ml of NS was injected into each side. The values of BP, HR, SPO2, SE, RE, SPI, NRS, Steward score, dosage of propofol, dexmedetomidine, and rocuronium, the number of patients who needed remifentanil, propofol, or diltiazem, puncture point, block plane, duration of anesthesia, catheter extraction, and wakefulness during the operation were monitored. There were no significant differences in the general data, number of cases requiring additional remifentanil, propofol, or diltiazem treatment, as well as puncture point and puncture plane between the two groups (P > 0.05). HR, SBP, and DBP values were higher in group Q than in group C at T1; HR, SPI, and SE, while RE values were lower in group Q than in group C at T3, SE, and RE; the Steward score was higher in group Q than in group C at T4 and T5, and the difference was statistically significant (P < 0.05). The extubation and awake times were lower in group Q than in group C, and the difference was statistically significant (P < 0.05). The SE, RE, and SPI values were lower at T1, T2, T3, and T4 than at T0. The Steward scores at T4 and T5 were higher in group Q than in group C, and were lower than at T0, with a statistically significant difference (P < 0.05). There were significant differences in the effectiveness of postoperative analgesia between the two groups at t1, t3 and t4 (P < 0.05). US-QLB in the supine position with OFA is effective in patients undergoing lower abdominal or pelvic surgery with stable intraoperative vital signs, complete recovery and better postoperative analgesia.
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Affiliation(s)
- Jingwei Dai
- Department of Anesthesiology, People's Hospital of Wanning, Wanning, 571500, Hainan, China
| | - Shanliang Li
- Department of Anesthesiology, People's Hospital of Wanning, Wanning, 571500, Hainan, China
| | - Qijun Weng
- Department of Anesthesiology, People's Hospital of Wanning, Wanning, 571500, Hainan, China
| | - Jinxiong Long
- Department of Anesthesiology, People's Hospital of Wanning, Wanning, 571500, Hainan, China
| | - Duozhi Wu
- Department of Anesthesiology, Hainan General Hospital, Haikou, 570311, Hainan, China.
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Kinjo S, Chernin T, Siegmueller C, Sharrow CM, Shilling A. Advances in regional anesthesia for ambulatory surgery. Int Anesthesiol Clin 2024; 62:54-61. [PMID: 37990922 DOI: 10.1097/aia.0000000000000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Sakura Kinjo
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California
| | - Tyler Chernin
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California
| | - Claas Siegmueller
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California
| | | | - Ashley Shilling
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
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10
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Ose G, Evansa I, Ivanovs N, Zlobina N, Vanags I, Sabelnikovs O. Percutaneous Gastrostomy Tube Placement under Quadratus Lumborum Block: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2106. [PMID: 38138209 PMCID: PMC10744729 DOI: 10.3390/medicina59122106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/27/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
The quadratus lumborum block is a technique that is not widely applied in abdominal surgery. The influence of the mode of anesthesia on the outcome of polymorbid patients is a controversial issue in the medical literature. We report a case in which we performed a quadratus lumborum block type 2 on a woman who was admitted to Riga's 1st hospital in need of gastrostomy, due to difficulty swallowing solid foods and liquids caused by hypopharynx carcinoma. On account of the patient's difficult airway, general anesthesia was deemed unsafe for the patient, with a risk of patient death. Percutaneous gastrostomy tube placement under a quadratus lumborum block type 2 was performed successfully.
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Affiliation(s)
- Gundega Ose
- Faculty of Medicine, Riga Stradins University, 1007 Riga, Latvia
| | - Irina Evansa
- Anesthesiology, Intensive Care and Pain Department, Riga 1st Hospital, 1001 Riga, Latvia
- Department of Anesthesiology and Intensive Care, Riga Stradins University, 1007 Riga, Latvia
| | - Nikita Ivanovs
- Anesthesiology, Intensive Care and Pain Department, Riga 1st Hospital, 1001 Riga, Latvia
| | - Natalija Zlobina
- Anesthesiology, Intensive Care and Pain Department, Riga 1st Hospital, 1001 Riga, Latvia
| | - Indulis Vanags
- Department of Anesthesiology and Intensive Care, Riga Stradins University, 1007 Riga, Latvia
- Clinic of Anesthesiology and Reanimatology, Paul Stradins Clinical University Hospital, 1002 Riga, Latvia
| | - Olegs Sabelnikovs
- Department of Anesthesiology and Intensive Care, Riga Stradins University, 1007 Riga, Latvia
- Clinic of Anesthesiology and Reanimatology, Paul Stradins Clinical University Hospital, 1002 Riga, Latvia
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11
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Sangkum L, Tangjitbampenbun A, Chalacheewa T, Brennan K, Liu H. Peripheral Nerve Blocks for Cesarean Delivery Analgesia: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1951. [PMID: 38004000 PMCID: PMC10673165 DOI: 10.3390/medicina59111951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
Effective postoperative analgesia using multimodal approach improves maternal and neonatal outcomes after cesarean delivery. The use of neuraxial approach (local anesthetic and opioids) and intravenous adjunctive drugs, such as nonsteroidal anti-inflammatory drugs and acetaminophen, currently represents the standard regimen for post-cesarean delivery analgesia. Peripheral nerve blocks may be considered in patients who are unable to receive neuraxial techniques; these blocks may also be used as a rescue technique in selected patients. This review discusses the relevant anatomy, current evidence, and advantages and disadvantages of the various peripheral nerve block techniques. Further research is warranted to compare the analgesic efficacy of these techniques, especially newer blocks (e.g., quadratus lumborum blocks and erector spinae plane blocks). Moreover, future studies should determine the safety profile of these blocks (e.g., fascial plane blocks) in the obstetric population because of its increased susceptibility to local anesthetic toxicity.
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Affiliation(s)
- Lisa Sangkum
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (L.S.); (A.T.); (T.C.)
| | - Amornrat Tangjitbampenbun
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (L.S.); (A.T.); (T.C.)
| | - Theerawat Chalacheewa
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (L.S.); (A.T.); (T.C.)
| | - Kristin Brennan
- Department of Anesthesiology, Penn Medicine Lancaster General Hospital, 555 N Duke St., Lancaster, PA 17602, USA;
| | - Henry Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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12
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Lee PS, Brunette LL, Sriprasert I, Eloustaz M, Deshpande R, Adams C, Muderspach L, Roman L, Dickerson S, Kim MP. Benefits of the Enhanced Recovery After Surgery (ERAS) Pathway With Quadratus Lumborum Blocks for Minimally Invasive Gynecologic Surgery Patients: A Retrospective Cohort Study. Cureus 2023; 15:e49183. [PMID: 38130508 PMCID: PMC10733622 DOI: 10.7759/cureus.49183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
STUDY OBJECTIVE This study aimed to determine the effect of the implementation of the Enhanced Recovery After Surgery (ERAS) protocol among patients receiving minimally invasive gynecologic surgery. DESIGN AND SETTING This retrospective cohort study was performed in a tertiary care hospital. PATIENTS A total of 328 females who underwent minimally invasive gynecologic surgeries requiring at least one overnight stay at Keck Hospital of University of Southern California (USC), California, USA, from 2016 to 2020 were included in this study. INTERVENTIONS The institutional ERAS protocol was implemented in late 2018. A total of 186 patients from 2016 to 2018 prior to the implementation were compared to 142 patients from 2018 to 2020 after the implementation. Intraoperatively, the ERAS group received a multimodal analgesic regimen (including bilateral quadratus lumborum (QL) blocks) and postoperative care geared toward a satisfactory, safe, and expeditious discharge. MEASUREMENTS AND MAIN RESULTS The two groups were similar in demographics, except for the shorter surgical time noted in the ERAS group. The median opioid use was significantly less among the ERAS patients compared with the non-ERAS patients on postoperative day 1 (7.5 vs. 14.3 mg; p<0.001) and throughout the hospital stay (17.4 vs. 36.2 mg; p<0.001). The ERAS group also had a shorter median hospital length of stay compared to the non-ERAS group (p<0.01). Among patients with a malignant diagnosis, patients in the ERAS group had significantly less postoperative day 1 and total opioid use and a shorter hospital stay (p<0.01). Within the ERAS group, 20% of the patients did not end up receiving a QL block. Opioid use and length of stay were similar between patients who did and did not receive the QL block. CONCLUSIONS The ERAS pathway was associated with a reduction in opioid use postoperatively and a shorter length of hospital stay after minimally invasive gynecologic surgery. There was a more significant decrease in opioid use and hospital length of stay for patients with malignant diagnoses compared to patients with benign diagnoses. Further research can be done to fully delineate the effect of QL blocks in ERAS protocols.
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Affiliation(s)
- Paul S Lee
- Anesthesiology, University of Southern California, Los Angeles, USA
| | - Laurie L Brunette
- Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
| | - Intira Sriprasert
- Obstetrics and Gynecology, Los Angeles County Medical Center and University of Southern California Medical Center, Los Angeles, USA
| | - Mohamed Eloustaz
- Anesthesiology, University of Southern California, Los Angeles, USA
| | - Rasika Deshpande
- Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
| | - Crystal Adams
- Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
| | - Laila Muderspach
- Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
| | - Lynda Roman
- Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
| | - Shane Dickerson
- Anesthesiology, University of Southern California, Los Angeles, USA
| | - Michael P Kim
- Anesthesiology, University of Southern California, Los Angeles, USA
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13
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Hummel A, Gaucher D, Wang P, Lawton DRY, Andrews SN, Nakasone CK. Higher intra-operative narcotic requirements and weakness with quadratus lumborum compared to paravertebral nerve block for total hip arthroplasty. Arch Orthop Trauma Surg 2023; 143:6849-6855. [PMID: 37269351 DOI: 10.1007/s00402-023-04925-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND This was a prospective single-blinded study comparing the peri-operative opioid consumption and motor weakness for patients undergoing total hip arthroplasty (THA) with either a Quadratus Lumborum Type 3 Nerve Block (QLB) or a Paravertebral Nerve Block (PVB). METHODS A consecutive cohort of patients undergoing elective anterior approach (AA) THA by a single high-volume surgeon were randomly assigned an anesthesiologist by the charge anesthesiologist. One anesthesiologist performed all QLBs, and the other six anesthesiologists performed the PVBs. Pertinent data include prospectively collected qualitative surveys from blinded medical personnel, floor nurses, and physical therapists as well as demographic information and post-operative complications. RESULTS Overall, 160 patients were included in the study divided equally between the QLB and PVB groups. The QLB group had a statistically higher peri-operative narcotic use (p < 0.001), greater intra-operative peak systolic blood pressure (p < 0.001) and respiratory rate (p < 0.001), and higher incidence of post-operative lower extremity muscle weakness (p = 0.040). There were no statistical group differences for floor narcotic use, post-operative hemoglobin levels or hospital length of stay. CONCLUSION The QLB required greater intraoperative narcotic use and resulted in greater post-operative weakness, however provided nearly equal post-operative pain management and did not adversely affect rapid discharge success. LEVEL OF EVIDENCE III, Non-randomized controlled cohort/follow-up study.
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Affiliation(s)
- Amelia Hummel
- John A Burns School of Medicine., University of Hawai'I, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Donald Gaucher
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Peter Wang
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Dylan R Y Lawton
- John A Burns School of Medicine., University of Hawai'I, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Samantha N Andrews
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA
- Department of Kinesiology and Rehabilitation Science, University of Hawai'I, 1337 Lower Campus Road, Honolulu, HI, 96822, USA
| | - Cass K Nakasone
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA.
- Department of Surgery, John A Burns School of Medicine, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA.
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14
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Long X, Yin Y, Guo W, Tang L. Ultrasound-guided quadratus lumborum block: a powerful way for reducing postoperative pain. Ann Med Surg (Lond) 2023; 85:4947-4953. [PMID: 37811106 PMCID: PMC10553186 DOI: 10.1097/ms9.0000000000001209] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/10/2023] [Indexed: 10/10/2023] Open
Abstract
Ultrasound-guided quadratus lumborum block (QLB) has been gradually carried out in clinical practice. However, some clinical evidence is contradictory, and no studies have summarized and described these results. The authors reviewed the anatomical characteristics of QLB and summarized the advantages and disadvantages of four puncture methods, so as to facilitate the clinical application of QLB.
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Affiliation(s)
- Xuechen Long
- Department of Anesthesiology, Northern Jiangsu People’s Hospital, Yangzhou
| | - Yibo Yin
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai
| | - Wenjun Guo
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Ling Tang
- Department of Anesthesiology, Northern Jiangsu People’s Hospital, Yangzhou
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15
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Alvi AS, Nasir JA, Nizam MA, Hamdani MM, Bhangar NA, Sibtain SA, Lalani AS, Warlé MC. Quadratus lumborum block and transversus abdominis plane block in laparoscopic nephrectomy: a meta-analysis. Pain Manag 2023; 13:555-567. [PMID: 37718911 DOI: 10.2217/pmt-2023-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Aim: To study the efficacy of quadratus lumborum block (QLB) and transversus abdominis plane (TAP) in laparoscopic nephrectomy patients. Materials & methods: We conducted a meta-analysis of randomized controlled trials for QLB and/or TAP technique compared with each other or a control. Results: Direct analysis of 24 h post-op pain score at rest for each compared with control showed significant reduction, QLB (mean differences [MD] [95% CI]: -1.12 [-1.87,-0.36]; p = 0.004) and TAP (MD [95% CI]: -0.36 [-0.59, -0.12]; p = 0.003). With movement both were respectively lower than control QLB (MD [95% CI]: -1.12 [-1.51, -0.72]; p = <0.0001) and TAP (MD [95% CI]: -0.50 [-0.95, -0.05]; p = 0.03). Moreover, QLB demonstrated less risk 24 h of post-op nausea vomiting (PONV) versus control (PONV; risk ratios [RR] [95% CI]: 0.64 [0.45,0.90]; p = 0.01). Conclusion: TAP and QLB reduce pain scores compared with control, whereas only QLB reduces PONV compared with control.
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Affiliation(s)
- Abdul S Alvi
- Department of Anaesthesiology, Ziauddin University, Clifton, Karachi, Sindh, 75000, Pakistan
| | - Jamal A Nasir
- Department of Anaesthesiology, Ziauddin University, Clifton, Karachi, Sindh, 75000, Pakistan
| | - Muhammad A Nizam
- Department of Anaesthesiology, Ziauddin University, Clifton, Karachi, Sindh, 75000, Pakistan
| | - Muhammad M Hamdani
- Department of Anaesthesiology, Ziauddin University, Clifton, Karachi, Sindh, 75000, Pakistan
| | - Nabeel A Bhangar
- Department of Anaesthesiology, Ziauddin University, Clifton, Karachi, Sindh, 75000, Pakistan
| | - Syed A Sibtain
- Department of Anaesthesiology, Ziauddin University, Clifton, Karachi, Sindh, 75000, Pakistan
| | - Ali S Lalani
- Department of Anaesthesiology, Ziauddin University, Clifton, Karachi, Sindh, 75000, Pakistan
| | - Michiel C Warlé
- Department of Surgery, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
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16
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Mao Y, Zhao W, Hao M, Xing R, Yan M. Ultrasound-Guided Quadratus Lumborum Block at the Lateral Supra-Arcuate Ligament versus Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia Following Open Hepatectomy: A Randomized Controlled Trial. J Pain Res 2023; 16:1429-1440. [PMID: 37138955 PMCID: PMC10150756 DOI: 10.2147/jpr.s404810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/31/2023] [Indexed: 05/05/2023] Open
Abstract
Purpose Many studies confirmed that several approaches of quadratus lumborum block (QLB) were superior to transversus abdominis plane block (TAPB) in reducing opioid consumption during postoperative period. As a new QLB approach at the lateral supra-arcuate ligament (QLB-LSAL), the analgesic efficacy and safety in patients undergoing open hepatectomy are still unknown. This study aims to compare postoperative analgesia between the blocks in open hepatectomy. Patients and Methods Sixty-two patients undergoing open hepatectomy were enrolled and randomly allocated into the QLB-LSAL group (group Q) and the subcostal TAPB group (group T). Preoperatively, patients received ultrasound-guided bilateral QLB-LSAL or subcostal TAPB with injection of 0.5% ropivacaine (a total volume of 40 mL). The primary outcome was cumulative total morphine equivalent consumption in the first postoperative 24 h. Other outcomes included numerical rating scale (NRS) scores at rest and coughing, cumulative total morphine equivalent consumption at 2, 6, 12, 48 h, Quality of Recovery-15 (QoR-15) scores, time to first patient-controlled intravenous analgesia (PCIA) request, time to first ambulation and adverse effects. Results The cumulative total morphine equivalent consumption in group Q was decreased significantly at all postoperative time points (P < 0.01). The postoperative NRS scores at rest and coughing in group Q were lower than those in group T at all postoperative time points except 48 h (P < 0.05). A significant increase was also observed in the QoR-15 scores among patients in group Q. Time to first PCIA request was significantly prolonged in group Q than in group T, and time to first ambulation was shortened. Adverse effects showed no statistical significance between the two groups. Conclusion Compared with subcostal TAPB, preoperative bilateral QLB-LSAL provided superior analgesic properties and promoted early postoperative recovery quality in patients undergoing open hepatectomy. Trial Registration China Clinical Trials Registration Center (http://www.chictr.org.cn) ChiCTR2200063291, 3/9/2022.
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Affiliation(s)
- Ye Mao
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, People's Republic of China
| | - Wei Zhao
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, People's Republic of China
| | - Mengxiao Hao
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, People's Republic of China
| | - Rui Xing
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, People's Republic of China
| | - Ming Yan
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, People's Republic of China
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17
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Omara AF, Elbadry AA, Abo Hagar AM. Quadratus Lumborum Block Against Coupled Transversus Abdominis Block and Ilioinguinal/Iliohypogastric Nerve Blocks for Postoperative Analgesia After Total Abdominal Hysterectomy: A Randomized Controlled Trial. Anesth Pain Med 2023; 13:e134845. [PMID: 37601960 PMCID: PMC10439688 DOI: 10.5812/aapm-134845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 08/22/2023] Open
Abstract
Background Nerve blocks have been one of the most common anesthetic methods for abdominal surgeries since the last four decades. Objectives This study aimed to compare the postoperative analgesic efficacy of bilateral ultrasound-guided quadratus lumborum block (QLB) against bilateral ultrasound-guided transversus abdominis block (TAB) and Ilioinguinal/Iliohypogastric nerve blocks (IINB) in abdominal total hysterectomy. Methods Sixty female patients scheduled for the surgery of total abdominal hysterectomy under spinal anesthesia participated in this randomized prospective trial. They were randomly assigned to two dual TAB / IINB (n = 30) and QLB (n = 30) groups. Moreover, the visual analog scores (VAS), the total amount of morphine consumed after surgery during the first 24 hours, the number of individuals requiring rescue analgesia, postoperative analgesia duration, and postoperative complications were recorded. Results Morphine consumption was equal in both groups (P = 0.908). Furthermore, the analgesia duration in the two groups was statistically insignificant (P = 0.879), with mean values of 15.4 and 15.6 hours, respectively. During 24 hours, there was no statistically significant difference in terms of VAS between the two groups (P > 0.05). Conclusions The QLB might be a viable replacement for TAB/IINB for postoperative analgesia after total abdominal hysterectomy.
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Affiliation(s)
- Amany Faheem Omara
- Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, P. O. Box: 31527, Tanta, Egypt
| | - Amr Arafa Elbadry
- Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, P. O. Box: 31527, Tanta, Egypt
| | - Alaa Mohammed Abo Hagar
- Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, P. O. Box: 31527, Tanta, Egypt
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18
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Brandão VGA, Silva GN, Perez MV, Lewandrowski KU, Fiorelli RKA. Effect of Quadratus Lumborum Block on Pain and Stress Response after Video Laparoscopic Surgeries: A Randomized Clinical Trial. J Pers Med 2023; 13:jpm13040586. [PMID: 37108972 PMCID: PMC10142610 DOI: 10.3390/jpm13040586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/01/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Background: There are many surgical and anesthetic factors that affect pain and the endocrine–metabolic response to trauma. The ability of anesthetic agents and neuronal blockade to modify the response to surgical trauma has been widely studied in the last few years. Objective: To evaluate if the anterior quadratus lumborum block contributes to improved surgical recovery, using as parameters analgesia, pulmonary function and neuroendocrine response to trauma. Methods: We carried out a prospective, randomized, controlled, and blinded study, in which 51 patients scheduled for laparoscopic cholecystectomy. Patients were randomly selected and assigned to 2 groups. The control group received balanced general anesthesia and venous analgesia, and the intervention group was treated under general, venous analgesia and anterior quadratus lumborum block. The parameters evaluated were: demographic data, postoperative pain, respiratory muscle pressure and inflammatory response to surgical stress with the plasma dosage of IL-6 (Interleukin 6), CRP (C-Reactive protein) and cortisol. Results: Anterior quadratus lumborum block induced the slowing of IL-6 cytokine production and a decrease in cortisol release. This effect was accompanied by the significant reduction of postoperative pain scores. Conclusion: Anterior quadratus lumborum block is an important strategy for analgesia in abdominal laparoscopic surgery and contributes to reducing the inflammatory response to surgical trauma with an early return of preoperative baseline physiological functions.
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19
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Abdelbaser I, Salah DM, Ateyya AA, Abdo MI. Ultrasound-guided transversalis fascia plane block versus lateral quadratus lumborum plane block for analgesia after inguinal herniotomy in children: a randomized controlled non-inferiority study. BMC Anesthesiol 2023; 23:82. [PMID: 36932317 PMCID: PMC10022034 DOI: 10.1186/s12871-023-02043-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Surgical repair of inguinal hernia is one of the most common day case surgeries in the pediatric population. This study compared the postoperative analgesic effects of transversalis fascia plane block (TFB) versus quadratus lumborum block (QLB) in children scheduled for open unilateral inguinal herniotomy. METHODS In this prospective, randomized, double-blind, controlled non-inferiority study, 76 eligible patients were recruited. Patients were randomly allocated to either the TFB or QLB group. The primary outcome measure was the proportion of patients who needed rescue analgesia during the first postoperative 12 h. The secondary outcomes were, the time needed to perform the block, the postoperative FLACC score, intraoperative heart rate (HR) and mean arterial pressure (MAP). RESULTS The proportion of patients who required a rescue analgesic was comparable (p = 1.000) between the TFB group (7/34, 20.5%) and the QLB group (6/34, 17.6%). The median [Q1-Q3] time needed to perform the block (min) was significantly longer (p < 0.001) in the QLB group (5[5]) compared with the TFB group. The postoperative FLACC pain scale was comparable between the two groups at all-time points of assessment. There is no difference regarding the heart rate and mean arterial blood pressure values at the time points that the values were recorded. (P > 0.005). CONCLUSIONS Both TFB and QLB similarly provide good postoperative analgesia by reducing the proportion of patients who required rescue analgesia, pain scores and analgesic consumption. Moreover, TFB is technically easier than QLB.
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Affiliation(s)
- Ibrahim Abdelbaser
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, 2 El-Gomhouria Street, Mansoura, 35516, Egypt.
| | - Doaa Mahmoud Salah
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, 2 El-Gomhouria Street, Mansoura, 35516, Egypt
| | - Amer Abdullah Ateyya
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, 2 El-Gomhouria Street, Mansoura, 35516, Egypt
| | - Marwa Ibrahim Abdo
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, 2 El-Gomhouria Street, Mansoura, 35516, Egypt
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20
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Oh SK, Lim BG. Quadratus lumborum block and erector spinae plane block, which one is more effective for open nephrectomy? Minerva Anestesiol 2023; 89:1-3. [PMID: 36326781 DOI: 10.23736/s0375-9393.22.17033-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Seok-Kyeong Oh
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Byung-Gun Lim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea -
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21
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Onay M, Erdoğan Kayhan G, Özen A, Şanal Baş S, Yelken B. Comparison of ultrasound-guided quadratus lumborum block and erector spinae plane block in terms of their effects on postoperative pain in open nephrectomy. Minerva Anestesiol 2023; 89:32-39. [PMID: 36287390 DOI: 10.23736/s0375-9393.22.16635-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Ultrasound-guided quadratus lumborum block (QLB 2) and erector spinae plane block (ESPB) were suggested to prevent somatic and visceral pain in a small number of abdominal surgeries. In this study, we aimed to compare these fascial plane blocks in terms of efficacy and safety in patients undergoing open nephrectomy. METHODS This double-blind randomized controlled trial included a total of 40 patients (aged 18-70 years, with an ASA Score of I-III) and underwent partial or radical nephrectomy with subcostal incision. Unilateral ESPB and QLB 2 were performed at the end of the operation. The patients were then assessed for total morphine consumption, pain scores, and side effects at the postoperative 24th hour. RESULTS The ESPB and QLB 2 groups showed similar total morphine consumption (20.95+12.40 mg and 25.05+13.60 mg, P=0.870) and morphine demands (37.85+29.43 and 41.15+31.75, P=1.000), respectively. Despite the lower VAS scores at rest and movement in the ESPB group, there were no statistically significant differences between groups. CONCLUSIONS Ultrasound-guided QLB 2 and ESP block were found to achieve similar results on at rest and at movement pain scores and morphine consumption of the patients undergoing open nephrectomy. Both blocks may be preferred, depending on the clinician's experience.
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Affiliation(s)
- Meryem Onay
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey -
| | - Gülay Erdoğan Kayhan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Ata Özen
- Department of Urology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Sema Şanal Baş
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Birgül Yelken
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
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Cao R, Li X, Yang J, Deng L, Cui Y. The minimum effective concentration (MEC90) of ropivacaine for ultrasound-guided quadratus lumborum block for analgesia after cesarean delivery: a dose finding study. BMC Anesthesiol 2022; 22:410. [PMID: 36581811 PMCID: PMC9798625 DOI: 10.1186/s12871-022-01954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/21/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Quadratus lumborum block was recently proposed as an alternative technique for post-cesarean delivery analgesia. However, there is not a definite optimum concentration of local anesthetics. A biased coin design up-and-down method was used to explore the minimum effective concentration of ropivacaine in quadratus lumborum block for satisfactory analgesia after cesarean delivery. METHODS Fifty-six patients weighing 60-80 kg after cesarean section and with ages between 18 and 40 years were recruited. For the posterior quadratus lumborum block, a volume of 25 ml of the assigned concentration of ropivacaine was injected bilaterally. The concentration administered to each patient depended on the response to the previous dose. The first patient received 0.25%. If a successful block was observed, the next patient was randomized to receive the same ropivacaine concentration (with a probability of 0.89) or 0.025% less (with a probability of 0.11). After any block failure, the concentration was always increased by 0.025% for the next. The study ended when 45 successful blocks were obtained. We defined effective quadratus lumborum block as a resting visual analog score ≤ 3 and the absence of a need for rescue anesthetics. RESULTS The 90% minimum effective concentration of ropivacaine was 0.335% (95% CI 0.306 to 0.375%), and the 99% minimum effective concentration was 0.371% (95% CI 0.355 to 0.375%). The sufentanil consumption was 11 (11,13) and 24 (22,27) μg at 12 and 24 hours after quadratus lumborum block, respectively. CONCLUSIONS The optimum dosage of ropivacaine is a 25 ml volume of 0.335% for quadratus lumborum block after cesarean delivery. TRIAL REGISTRATION The study was registered in the Chinese Clinical Trial Registry (No. ChiCTR2000040415 ).
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Affiliation(s)
- Rong Cao
- grid.489962.80000 0004 7868 473XDepartment of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s and Children’s Central Hospital, Chengdu, 610091 China
| | - Xuehan Li
- grid.412901.f0000 0004 1770 1022Department of Anesthesiology, and Laboratory of Anesthesia and Intensive Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Yang
- grid.489962.80000 0004 7868 473XDepartment of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s and Children’s Central Hospital, Chengdu, 610091 China
| | - Lingmei Deng
- grid.489962.80000 0004 7868 473XDepartment of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s and Children’s Central Hospital, Chengdu, 610091 China
| | - Yu Cui
- grid.489962.80000 0004 7868 473XDepartment of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s and Children’s Central Hospital, Chengdu, 610091 China
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23
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Yetik F, Yilmaz C, Karasu D, Haliloğlu Dastan N, Dayioğlu M, Baytar Ç. Comparison of ultrasound-guided quadratus lumborum block-2 and quadratus lumborum block-3 for postoperative pain in cesarean section: A randomized clinical trial. Medicine (Baltimore) 2022; 101:e31844. [PMID: 36626453 PMCID: PMC9750657 DOI: 10.1097/md.0000000000031844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION The aim of this study was to compare the postoperative analgesic effects of ultrasound-guided quadratus lumborum block-2 (QLB-2) and quadratus lumborum block-3 (QLB-3) after cesarean section (C/S) under general anesthesia. METHOD This was a prospective, randomized, double-blind study. A total of 143 term pregnant women with American Society of Anesthesiologists II status, who were scheduled for elective C/S under general anesthesia were randomly separated into QLB-2 and QLB-3 groups. After surgery under standardized general anesthesia, QLBs were performed with 0.3 mL.Kg-1 0.25% bupivacaine in both groups. Patient-controlled analgesia (PCA) devices were used for additional analgesia. The primary outcomes were pain scores evaluated at 0, 2, 6, 12, and 24 hours. In addition, PCA demands, actual delivered tramadol doses, rescue analgesic requirements, anesthesia time, and patient satisfaction were recorded. RESULTS A total of 104 patients were analyzed statistically. Pain scores were statistically lower in the QLB-3 group at 2, 6, 12, and 24 hours postoperatively (P = .001). Anesthesia time was longer in the QLB-3 group. Patients who received QLB-3 block demonstrated significantly fewer PCA demands and lower consumption of tramadol (P = .003). Moreover, the first analgesic requirement time was longer along with higher patient satisfaction. In addition, all procedures were performed without any complications and side effects due to PCA were negligible. CONCLUSIONS This study demonstrated that, although both QLBs were safe and reliable, QLB-3 provides more effective analgesia and patient satisfaction than QLB-2 in C/S.
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Affiliation(s)
- Ferit Yetik
- Gemlik State Hospital, Department of Anesthesiology and Reanimation, Bursa, Turkey
| | - Canan Yilmaz
- Health Sciences University, Bursa Yüksek Ihtisas Training and Education Hospital, Department of Anesthesiology and Reanimation, Bursa, Turkey
| | - Derya Karasu
- Health Sciences University, Bursa Yüksek Ihtisas Training and Education Hospital, Department of Anesthesiology and Reanimation, Bursa, Turkey
| | - Nesibe Haliloğlu Dastan
- Gülhane Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Mürüvvet Dayioğlu
- Gazi University, Department of Anesthesiology and Reanimation, Division of Intensive Care, Ankara, Turkey
| | - Çağdaş Baytar
- Zonguldak Bülent Ecevit University Medicine Faculty, Department of Anesthesiology and Reanimation, Zonguldak, Turkey
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He WQ, Li YJ, Li YS, Zhang XH, Cao J, Lu KZ, Cheung CW, Gu JT, Xia ZY, Yi B. Advantages of Transmuscular Quadratus Lumborum Block via Subfascial Approach Versus Extrafascial Approach for Postoperative Analgesia After Laparoscopic Cholecystectomy: A Randomized Controlled Study. Clin J Pain 2022; 38:730-738. [PMID: 36221155 PMCID: PMC9645534 DOI: 10.1097/ajp.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 08/22/2022] [Accepted: 09/30/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE We aimed to compare the analgesic effect and incidence of lower limb weakness of transmuscular quadratus lumborum (TQL) block via subfascial approach with that via extrafascial after laparoscopic cholecystectomy (LC). METHODS Eighty patients undergoing LC were randomized to receive ultrasound-guided bilateral TQL block via subfascial (subfascial group) or extrafascial (extrafascial group) using 30 mL of 0.33% ropivacaine unilaterally. Pain scores of port sites while rest and coughing at 1, 6, 12, 24, 36, and 48 hours postoperatively as primary outcome were compared. Modified Lovett Rating Scale, ambulatory dependency, and rescue analgesia requirement was also compared. RESULTS The pain score of the subxiphoid and of the right subcostal port site for up to the postoperative 36 hours (2 [1 to 2]) and 24 hours (2 [2 to 3]) in the subfascial group was significantly lower than that in extrafascial group (2 [2 to 2] and 3 [2.25 to 4]). Up to postoperative 24 hours, the rescue analgesia requirement in subfascial group was significantly lower than that in extrafascial group, namely less fentanyl consumption and parecoxib (1.3 [±5.5] μg vs. 5.6 [±10.6] μg; 17.5% vs. 37.5%). The ratio of patients with LRS score of 6 at postoperative 1 hour (65.0%), and with dependent ambulation at postoperative 1 and 6 hours in subfascial group (15.0% and 0.0%) was significantly lower than that in extrafascial group (10.0%, 80.0%, and 17.5%). CONCLUSION TQL block via subfascial had the advantages of better analgesic effect and less lower limbs weakness after LC over that via extrafascial.
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Affiliation(s)
- Wen-quan He
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Yu-jie Li
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Yong-shuai Li
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Xu-hao Zhang
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Jian Cao
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Kai-zhi Lu
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Chi Wai Cheung
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, University of Hong Kong, HKSAR
| | - Jian-teng Gu
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
| | - Zheng-yuan Xia
- Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Bin Yi
- Department of Anaesthesiology, Southwest Hospital, The Third Military Medical University, Chongqing
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Ultrasound-Guided Anterior Quadratus Lumborum Block at Lateral Supra-Arcuate Ligament vs Thoracic Epidural Analgesia after Open Liver Surgery: A Randomized, Controlled, Noninferiority Trial. J Am Coll Surg 2022; 235:871-878. [PMID: 36102582 DOI: 10.1097/xcs.0000000000000354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Thoracic epidural analgesia (TEA) has demonstrated great analgesic benefits in open liver surgery. However, the increased risk of postoperative coagulopathy after open liver surgery has promoted interest in alternate analgesic research. We aimed to explore whether ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament (LAL-QLB) with intravenous analgesia was noninferior to TEA under multimodal analgesia after open liver surgery. STUDY DESIGN Seventy-four patients undergoing open liver surgery were randomized (1:1) to the LAL-QLB or TEA group in this open-label study. The primary outcome was the numeric rating scale during coughing at 24 hours postoperatively with a noninferiority limit of 1. RESULTS The mean difference of numeric rating scale during coughing at 24 hours postoperatively was 0.32 (95% CI -0.03 to 0.68), showing noninferiority. The TEA group had better pain scores at 1 and 6 hours, and the early postoperative pain of the LAL-QLB group was within the clinically acceptable limit with no differences at other time points. The LAL-QLB group received more opioids within 24 hours postoperatively. There were no differences in analgesia-related adverse reactions or rescue analgesia. Postoperative coagulopathy was responsible with 19.4% of delayed epidural removal. TEA outperformed LAL-QLB in terms of ambulation and bowel recovery. There were no differences in hospital stay or 30-day postoperative complications. CONCLUSIONS LAL-QLB provided noninferior analgesia at 24 hours postoperatively. Despite regarding coagulopathy and delayed epidural removal, TEA was found to be better than LAL-QLB for pain management after open liver surgery. Epidural removal required close coagulation test.
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Shao L, Luo X, Ye Y, Liu L, Cai Y, Xia Y, Papadimos TJ, Wang Q, Pan L. Anterior Quadratus Lumborum block area comparison in the three different volumes of Ropivacaine: a double-blind, randomized controlled trial in healthy volunteers. BMC Anesthesiol 2022; 22:365. [PMID: 36447137 PMCID: PMC9706850 DOI: 10.1186/s12871-022-01922-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In abdominal surgery, ultrasound-guided anterior quadratus lumborum blocks (QLB) are performed to induce analgesia. However, no study reported suitable volumes of the anterior QLB for the different postoperative analgesia regions. Therefore, this prospective randomized controlled study assessed the dermatomal spread and analgesic effects of the three different volumes of a local anesthetic for anterior QLB. METHODS Ultrasound-guided anterior QLB was performed at the L2 level on 30 healthy volunteers. The volunteers were randomized to receive 20 ml (n = 10), 30 ml (n = 10), and 40 mL (n = 10) of 0.375% ropivacaine. The cutaneous sensory blocked area (CSBA), the number of block dermatomes, and the block duration time were measured by determining the extent of the cold sensation. RESULTS The CSBA was significantly larger in the 40 ml group than in the 30 (P = 0.001; 1350.6 ± 234.4 vs. 1009.5 ± 151.6 cm2) and 20 ml groups (P < 0.001; 1350.6 ± 234.4 vs. 808.1 ± 120.5 cm2). Similarly, the number of blocked dermatomes was significantly higher in the 40 ml group than in the 30- and 20-ml groups. However, no significant difference was observed in block duration among the groups. CONCLUSIONS No difference was observed in block duration with the various volumes of 0.375% ropivacaine. However, the larger volume for anterior QLB contributed to a larger area of cutaneous sensory blockade. Appropriate volumes in anterior QLB can create suitable postoperative analgesia levels for the different operative sites. TRIAL REGISTRATION The study was registered in the Chinese Clinical Trial Registration Center on www.chictr.org.cn on 27th April 2018 (registration number: ChiCTR-IOR-17010853).
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Affiliation(s)
- Liang Shao
- Department of Anesthesiology, the People’s Hospital of Yuhuan, Taizhou City, 317600 Zhejiang Province China ,grid.268099.c0000 0001 0348 3990Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000 Zhejiang Province China
| | - Xu Luo
- grid.268099.c0000 0001 0348 3990Department of Burn, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000 Zhejiang Province China
| | - Yingchao Ye
- grid.268099.c0000 0001 0348 3990Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000 Zhejiang Province China
| | - Le Liu
- grid.268099.c0000 0001 0348 3990Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000 Zhejiang Province China
| | - Yaoyao Cai
- grid.268099.c0000 0001 0348 3990Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000 Zhejiang Province China
| | - Yun Xia
- grid.412332.50000 0001 1545 0811Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Thomas J. Papadimos
- grid.412332.50000 0001 1545 0811Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Quanguang Wang
- grid.268099.c0000 0001 0348 3990Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000 Zhejiang Province China
| | - Linmin Pan
- grid.268099.c0000 0001 0348 3990Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000 Zhejiang Province China
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Lee S, Kang RA, Kim GS, Gwak MS, Choi GS, Kim JM, Ko JS. Comparison of postoperative analgesic effects of posterior quadratus lumborum block and intrathecal morphine in laparoscopic donor hepatectomy: a prospective randomized non-inferiority clinical trial. Reg Anesth Pain Med 2022; 47:527-533. [DOI: 10.1136/rapm-2022-103577] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/19/2022] [Indexed: 01/13/2023]
Abstract
BackgroundPosterior quadratus lumborum block (QLB) and intrathecal morphine are accepted analgesic strategies in laparoscopic liver resection, but their effects have not been compared after laparoscopic donor hepatectomy. This study was planned to perform this comparison.MethodsFifty-six donors were randomized to receive bilateral posterior (QLB2, 20 mL of 0.375% ropivacaine on each side, 150 mg total) or preoperative injection of 0.4 mg morphine sulfate intrathecally. Primary outcome was resting pain score at 24 hour postsurgery. Secondary outcomes included cumulative opioid consumption and recovery parameters. Serial plasma ropivacaine concentrations were measured in QLB group. Only the outcome assessor was properly blinded.ResultsMean resting pain score at 24-hour postsurgery was 4.19±1.66 in QLB group (n=27) and 3.07±1.41 in intrathecal morphine group (n=27, p=0.04). Mean difference (QLB group-intrathecal morphine group) was 1.11 (95% CI 0.27 to 1.95), and the upper limit of CI was higher than prespecified non-inferiority margin (δ=1), indicating an inferior effect of QLB. Cumulative opioid consumption was significantly higher in QLB group at 24 hours and 48 hours postsurgery. QLB group exhibited lower incidence of postoperative pruritus at all time points, and there were no differences in other recovery outcomes. All measured ropivacaine concentrations were below the threshold for systemic toxicity (4.3 µg/mL).ConclusionsBilateral posterior QLB elicited higher resting pain scores at 24-hour after laparoscopic donor hepatectomy than intrathecal morphine and did not meet the definition of non-inferiority.Trial registration numberKCT0005360.
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Elwakil M, Tharwat J, Abbas D, Elwaseef M, Elgendy S. Comparative Study between Ultrasound-Guided Quadratus Lumborum Block Type 2 Versus Lumbar Epidural Analgesia as a Perioperative Analgesic Technique for Pelvic Cancer Surgeries. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The effect of the quadratus lumborum block (QLB) is believed to result from a spread of LA from its lumbar deposition cranially into the thoracic paravertebral space.The aim of this study is to compare the analgesic efficacy of an Ultrasound-guided quadrates lumborum type II block versus lumbar epidural analgesia or conventional analgesia after pelvic cancer surgeries regarding intraoperative fentanyl consumption, postoperative pain scores and morphine consumption in the first 24 hours.Methods: This study was conducted on 90 patients of American Society of Anesthesia (ASA) physical status II scheduled for elective pelvic cancer operations. Patients were randomized into three equal groups of 30 patients: Group Q: received bilateral QLB by 20ml of 0.25% bupivacaine in each side, Group E: received continuous lumbar epidural block analgesia ((0.125 % bupivacaine at infusion rate of 6ml/hour for 24 hours). Group C (Control group): were transferred to operation room without further intervention.Results: End tidal sevoflurane was significantly decreased in group Q than group C and in group E than group C at all time measurements. VAS at 0.5, 1, 8. 16 and 24 hours was significantly increased in group C than Group Q and group E. Time to first rescue dose of morphine was significantly increased in Group E than Group Q (P1 <0.001) and was significantly decreased in group C than Group Q (P2 <0.001) and was significantly decreased in group C than Group E (P3 <0.001). Total dose of morphine in 1st 24 hours was significantly increased at group C than group Q and group E (P <0.001) but there was an insignificant difference between Group Q and E.Conclusion: When compared to the control group, QLB and epidural block resulted in decreased VAS, intraoperative sevoflurane and fentanyl use and postoperative morphine consumption with a greater level of patient satisfaction. Epidural block, on the other hand, resulted in less intraoperative sevoflurane usage than QLB.
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Karadeniz MS, Tefik T, Erdem S, Dincer MB, Aktas S, Ciftci HS, Salviz EA, Tugrul KM. Quadratus Lumborum Block with Laparoscopic Assisted Catheter Placement Technique in Donor Nephrectomy: A Preliminary Report. Transplant Proc 2022; 54:1759-1762. [PMID: 35863995 DOI: 10.1016/j.transproceed.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 04/27/2022] [Accepted: 05/22/2022] [Indexed: 10/17/2022]
Abstract
Quadratus lumborum block (QLB) is a new fascial plane block that may be helpful for laparoscopic surgeries. In this present study, we aim to evaluate the analgesic efficacy of QLB in laparoscopic living related donor nephrectomy (LLRDN) applied continuously via a catheter that was placed under laparoscopic vision by the surgeon. Following the approval of the Clinical Research Ethics Committee of Istanbul University, Istanbul Medical Faculty (2019/1552), 9 study (Group QLB) and 26 control (Group M) patients that underwent LLRDN were enrolled in this retrospective study. All donors underwent left nephrectomy via transperitoneal laparoscopic approach. An epidural catheter was placed between the QL and psoas major (PM) fascial plane intraoperatively by the surgeon under laparoscopic direct vision, and bupivacaine 0.25% 20 mL was injected through the catheter. After the operation, for group QLB, we used a continuous infusion of bupivacaine 0.1% 7 mL/h over 24 hours. Group M patients received intravenous morphine patient controlled analgesia for 24 hours, postoperatively. Pain scores, total morphine consumption, and complications during the first 24 hours after surgery were recorded. During the first postoperative 24 hours, morphine requirement decreased by more than 70% in Group QLB (Group QLB: 5.11 ± 1.16 mg vs Group M: 16.8 ± 7.1 mg) (P < .0001). Postoperative Numeric Rating Scale (NRS) values at the 45th minute and first hour were both significantly lower in Group QLB than Group M (P < .01). This preliminary report showed that QL catheter placement technique provides good postoperative analgesia in patients undergoing LLRDN. However, further randomized controlled studies with extended patient numbers are required to test the efficacy of the technic.
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Affiliation(s)
- Meltem Savran Karadeniz
- Istanbul University, Istanbul Faculty of Medicine, Department of Anesthesia, Istanbul, Turkey.
| | - Tzevat Tefik
- Istanbul University, Istanbul Faculty of Medicine, Department of Urology, Istanbul, Turkey
| | - Selcuk Erdem
- Istanbul University, Istanbul Faculty of Medicine, Department of Urology, Istanbul, Turkey
| | - Muserref Beril Dincer
- Istanbul University, Istanbul Faculty of Medicine, Department of Anesthesia, Istanbul, Turkey
| | - Salih Aktas
- Istanbul University, Istanbul Faculty of Medicine, Department of Anesthesia, Istanbul, Turkey
| | - Hayriye Senturk Ciftci
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Biology, Istanbul, Turkey
| | - Emine Aysu Salviz
- Istanbul University, Istanbul Faculty of Medicine, Department of Anesthesia, Istanbul, Turkey
| | - Kamil Mehmet Tugrul
- Istanbul University, Istanbul Faculty of Medicine, Department of Anesthesia, Istanbul, Turkey
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Hu Z, Zhou Y, Zhao G, Zhang X, Liu C, Xing H, Liu J, Wang F. Effects of quadratus lumborum block on perioperative multimodal analgesia and postoperative outcomes in patients undergoing radical prostatectomy. BMC Anesthesiol 2022; 22:213. [PMID: 35820804 PMCID: PMC9277940 DOI: 10.1186/s12871-022-01755-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate the effects of ultrasound-guided quadratus lumborum block (QLB) on perioperative multimodal analgesia and postoperative outcomes in patients undergoing radical prostatectomy. METHODS A total of 80 patients undergoing radical prostatectomy were randomly divided into two groups: general anaesthesia with QLB (QLB group; n = 40) and general anaesthesia with sham QLB (normal saline [NS] group; n = 40). QLB or sham QLB was performed before the induction of anaesthesia. Sufentanil was intravenously administered for postoperative analgesia. The primary outcome was the pain score (measured using a numerical rating scale [NRS]) at different time points within 48 h postoperatively. Secondary outcomes included the cumulative dose of sufentanil within 48 h postoperatively, subjective comfort, grip strength, first time of exhaustion, first fluid intake time, time to get out of bed, length of postoperative hospital stay and overall satisfaction. The SPSS software, version 17.0, was used for all statistical analyses. RESULTS Postoperative NRS at rest was significantly lower at 2 h (1.7 ± 1.1 versus 3.0 ± 2.1), 4 h (1.8 ± 1.2 versus 4.1 ± 2.3), 6 h (1.9 ± 2 versus 4.4 ± 2) and 12 h (3.5 ± 2.3 versus 5 ± 3.3) and was also lower when coughing at 2 h (2.3 ± 1.1 versus 4 ± 2.1), 4 h (2.3 ± 1. 1 versus 4.3 ± 2) and 6 h (2.4 ± 1.1 versus 5.9 ± 2.3) in the QLB than that in the NS group. The cumulative dose of sufentanil was significantly lower in the QLB than that in the NS group at 4 h, 6 h, 12 h, 24 h and 48 h. The nausea score was significantly lower in the QLB group at 24 h postoperatively, and the first time of exhaustion and time to get out of bed were significantly shorter (P < 0.05). The overall satisfaction score was significantly higher in the QLB than in the NS group (4 ± 0.7 versus 2.6 ± 0.9). CONCLUSION Ultrasound-guided bilateral QLB can provide effective postoperative analgesia for patients undergoing radical prostatectomy, reduce the need for sufentanil, facilitate comfort and improve postoperative outcomes. QLB can be a good component of multimodal analgesia. TRIAL REGISTRATION The clinical trial is registered in the Chinese Clinical Trial Registry (ChiCTR). Current Controlled Trials: ChiCTR1900022009 . the date of registration:2019/03/20.
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Affiliation(s)
- Zhen Hu
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongi University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Yingjie Zhou
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongi University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Guohao Zhao
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongi University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Xinxin Zhang
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongi University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Chunchun Liu
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongi University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Huan Xing
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongi University School of Medicine, Shanghai, 200072, People's Republic of China
| | - Ji Liu
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, Shanghai, 200072, People's Republic of China
| | - Fen Wang
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongi University School of Medicine, Shanghai, 200072, People's Republic of China.
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Sertcakacilar G, Yildiz GO. Analgesic efficacy of ultrasound-guided transversus abdominis plane block and lateral approach quadratus lumborum block after laparoscopic appendectomy: A randomized controlled trial. Ann Med Surg (Lond) 2022; 79:104002. [PMID: 35860161 PMCID: PMC9289327 DOI: 10.1016/j.amsu.2022.104002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 10/25/2022] Open
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Lateral Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Laparoscopic Surgery: A Randomized Controlled Study. Anesthesiol Res Pract 2022; 2022:9201795. [PMID: 35386840 PMCID: PMC8979728 DOI: 10.1155/2022/9201795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background After laparoscopic abdominal surgery, we aim to evaluate the analgesic efficiency of US-directed bilateral transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB). Methods 50 patients aged 18–60 years listed for elective laparoscopic abdomen operation were registered in this study. Cases were randomly allocated into two similar groups: TAPB and QLB groups. The first outcome was the growing morphine consumption on the 1st day postoperatively. The second outcome involved VAS score, first analgesic necessities, and any postoperative complications. Statistical analysis was done with the 2-sample t-test, and Mann–Whitney U testing was utilized to compare medians for skewed end points. Qualitative data were introduced as numbers and percentages, and chi-squared testing was utilized to determine the significance. Results The median cumulative morphine consumptions on the 1st day were high significantly in the TAPB group than in the QLB group (6 mg [6, 9] vs. 3 mg [3, 6], p value ≤0.0001]). The QLB group showed an increase in the median of the time to the first analgesic request in comparison with the TAPB group (17 hours [12, 24] vs. 8 hours [6, 24], p ≤ 0.001). In addition, on the 1st day, the mean VAS scoring at rest was lower in the QLB group. Conclusion In comparison to the TAPB, the QL block delivers more successful pain relief, has an extended period of analgesic actions, extends interval to the 1st analgesic necessity, is accompanied with lesser morphine consumptions, and may be utilized in multimodal analgesia and opioid-sparing regimens after that laparoscopic operation. This trial is registered with NCT04553991.
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Xue Q, Chu Z, Zhu J, Zhang X, Chen H, Liu W, Jia B, Zhang Y, Wang Y, Huang C, Hu X. Analgesic Efficacy of Transverse Abdominis Plane Block and Quadratus Lumborum Block in Laparoscopic Sleeve Gastrectomy: A Randomized Double-Blinded Clinical Trial. Pain Ther 2022; 11:613-626. [PMID: 35312948 PMCID: PMC9098772 DOI: 10.1007/s40122-022-00373-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/07/2022] [Indexed: 10/27/2022] Open
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White L, Ji A. External oblique intercostal plane block for upper abdominal surgery: use in obese patients. Br J Anaesth 2022; 128:e295-e297. [DOI: 10.1016/j.bja.2022.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/13/2022] [Accepted: 02/13/2022] [Indexed: 11/02/2022] Open
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Li Y, Lin C, Liu J. Ultrasound-guided quadratus lumborum block for postoperative analgesia in renal surgery: a systematic review and meta-analysis of randomized controlled trials. J Anesth 2022; 36:254-264. [DOI: 10.1007/s00540-022-03040-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/09/2022] [Indexed: 12/12/2022]
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Ambasta S, Kulhari S, Shamshery C, Agarwal A, Singh R, Srivastava M. Postoperative analgesic efficacy of quadratus lumborum block in patients undergoing laparoscopic cholecystectomy: A retrospective study. INDIAN JOURNAL OF PAIN 2022. [DOI: 10.4103/ijpn.ijpn_92_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kang R, Lee S, Kim GS, Jeong JS, Gwak MS, Kim JM, Choi GS, Cho YJ, Ko JS. Comparison of Analgesic Efficacy of Erector Spinae Plane Block and Posterior Quadratus Lumborum Block in Laparoscopic Liver Resection: A Randomized Controlled Trial. J Pain Res 2021; 14:3791-3800. [PMID: 34924770 PMCID: PMC8674667 DOI: 10.2147/jpr.s343366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/04/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose Ultrasound-guided fascial plane blocks, including the erector spinae plane (ESP) and quadratus lumborum (QL) blocks, provide effective postoperative abdominal analgesia. However, there is limited evidence on the analgesic efficacy of ESP and QL blocks after liver surgery. Therefore, we aimed to compare the cumulative opioid consumption between the ESP and QL blocks in patients with hepatocellular carcinoma undergoing laparoscopic liver resection. Patients and Methods Eighty-eight patients scheduled to undergo laparoscopic liver resection were randomized to receive bilateral single injection of ESP block at T8 (ESP group) or bilateral single injection of posterior QL block (QL group; 20 mL of 0.375% ropivacaine for each side, ie, total 150 mg of ropivacaine), in addition to intravenous (IV) fentanyl patient-controlled analgesia and multimodal analgesia. The primary outcome was cumulative opioid consumption over the first 24 h, expressed as IV morphine equivalents. Secondary outcomes included serial plasma ropivacaine concentrations, pain scores, time to first flatus, and Quality of Recovery-15 scores. Results Eighty-five patients were analyzed (ESP group, n = 42; QL group, n = 43). Cumulative 24-h opioid consumption was similar between the ESP and QL groups (41.4 ± 22.6 mg vs 44.2 ± 20.0 mg, mean difference (QL-ESP), 2.8 mg, 95% confidence interval, −6.4 to 12 mg, p > 0.99). There were no significant differences in resting pain scores at 24, 48 and 72 h postoperatively or recovery outcomes. The peak plasma ropivacaine concentration 30 min after injection was significantly higher in the ESP group (1.5 ± 0.3 µg/mL) than in the QL group (1.3 ± 0.5 µg/mL, p = 0.035); however, both were lower than the arterial threshold value of systemic toxicity (4.3 µg/mL). Conclusion ESP and QL blocks provided similar postoperative analgesia in patients undergoing laparoscopic liver resection.
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Affiliation(s)
- RyungA Kang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seungwon Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gaab Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Seon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Sook Gwak
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Jee Cho
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Justin Sangwook Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Daghmouri MA, Chaouch MA, Oueslati M, Rebai L, Oweira H. Regional techniques for pain management following laparoscopic elective colonic resection: A systematic review. Ann Med Surg (Lond) 2021; 72:103124. [PMID: 34925820 PMCID: PMC8648937 DOI: 10.1016/j.amsu.2021.103124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Pain management is an integral part of Enhanced Recovery After Surgery (ERAS) following laparoscopic colonic resection. A variety of regional and neuraxial techniques were proposed, but their efficacy is still controversial. This systematic review evaluates published evidence on analgesic techniques and their impact on postoperative analgesia and recovery for laparoscopic colonic surgery patients. Methods We conducted bibliographic research on May 10, 2021, through PubMed, Cochrane database, and Google scholar. We retained meta-analysis and randomized clinical trials. We graded the strength of clinical data and subsequent recommendations according to the Oxford Centre for Evidence-Based Medicine. Results Twelve studies were included. Thoracic epidural analgesia improved postoperative analgesia and bowel function following laparoscopic colectomy. However, it lengthens the hospital stay. Transversus abdominis plane block was as effective as thoracic epidural analgesia concerning pain control but with better postoperative recovery and lower length of hospital stay. Moreover, Lidocaine intravenous infusion improved postoperative pain management and recovery; Quadratus lumborum block provided similar postoperative analgesia and recovery. Finally, wound infiltration reduced postoperative pain without improving recovery of bowel function, and it could be proposed as an alternative to thoracic epidural analgesia. Conclusions Several analgesic techniques have been investigated. We found that abdominal wall blocks were as effective as thoracic epidural analgesia for pain management but with lower hospital stay and better recovery. We registered this review on PROSPERO (ID: CRD42021279228). First systematic review assessing the efficacy of analgesic techniques following laparoscopic elective colonic resection. Only colonic resection was evaluated contrary to other studies, including rectal surgery. High-quality studies (randomized controlled trials and meta-analyses) were assessed.
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Affiliation(s)
| | - Mohamed Ali Chaouch
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, University of Monastir, Tunisia
| | - Maroua Oueslati
- Department of Anesthesia, Trauma Center of Ben Arrous, University of Manar, Tunisia
| | - Lotfi Rebai
- Department of Anesthesia, Trauma Center of Ben Arrous, University of Manar, Tunisia
| | - Hani Oweira
- Department of Surgery, Universitätsmedizin Mannheim, S, Heidelberg University, Mannheim, Germany
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The Current Consideration, Approach, and Management in Postcesarean Delivery Pain Control: A Narrative Review. Anesthesiol Res Pract 2021; 2021:2156918. [PMID: 34589125 PMCID: PMC8476264 DOI: 10.1155/2021/2156918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/04/2021] [Indexed: 12/25/2022] Open
Abstract
Optimal postoperative analgesia has a significant impact on patient recovery and outcomes after cesarean delivery. Multimodal analgesia is the core principle for cesarean delivery and pain management. For a standard analgesic regimen, the use of long-acting neuraxial opioids (e.g., morphine) and adjunct drugs, such as scheduled acetaminophen and nonsteroidal anti-inflammatory drugs, is recommended unless contraindicated. Oral or intravenous opioids should be reserved for breakthrough pain. In addition to the aforementioned use of multimodal analgesia, preoperative evaluation is critical to individualize the analgesic regimen according to the patient requirements. Risk factors for severe postoperative pain or analgesia-related adverse effects will require modifications to the standard analgesic regimen (e.g., the use of ketamine, gabapentinoids, or regional anesthetic techniques). Further investigation is required to determine analgesic drugs or dose alterations based on preoperative predictions for patients at risk of severe pain. Outcomes beyond pain and analgesic use, such as functional recovery, should be determined to evaluate analgesic treatment protocols.
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Effect of Subcostal Anterior Quadratus Lumborum Block vs. Oblique Subcostal Transversus Abdominis Plane Block after Laparoscopic Radical Gastrectomy. Curr Med Sci 2021; 41:974-980. [PMID: 34562209 DOI: 10.1007/s11596-021-2429-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/20/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the analgesic effect of ultrasound-guided subcostal anterior quadratus lumborum block (QLB) for laparoscopic radical gastrectomy surgery. METHODS Patients (aged 20-65 years, ASA I - II, and weighing 40-75 kg) scheduled for elective laparoscopic radical gastrectomy were enrolled in the current study. Sixty patients were randomly assigned to two groups by computer-generated randomization codes: an ultrasound-guided oblique subcostal transversus abdominis plane block (TAPB) group (group T, n=30) or an ultrasound-guided subcostal anterior QLB group (group Q, n=30). In both groups, bilateral ultrasound-guided oblique subcostal TAPB and subcostal anterior QLB were performed before general anesthesia with 0.25% ropivacaine 0.5 mL/kg. For postoperative management, all patients received patient-controlled intravenous analgesia (PCIA) with nalbuphine and sufentanil after surgery, maintaining visual analogue scale (VAS) scores ≤4 within 48 h. The intraoperative consumption of remifentanil, the requirement for sufentanil as a rescue analgesic, and the VAS scores at rest and coughing were recorded at 1, 6, 12, 24 and 48 h after surgery. The recovery (extubation time after surgery, first ambulation time, first flatus time and length of postoperative hospital stay) and the adverse events (nausea and vomiting, skin pruritus, respiratory depression and nerve-block related complications) were observed and recorded. The primary outcome was the perioperative consumption of opioids. RESULTS Compared with group T, the intraoperative consumption of remifentanil, requirement for sufentanil and the frequency of PCIA were reduced in group Q. Meanwhile, VAS scores at all points of observation were significantly lower in group Q than in group T. Patients in group Q were also associated with shorter time to first out-of-bed activity and flatus, and shorter length of postoperative hospital stay than group T (P<0.05). There were no skin pruritus, respiratory depression or nerve-block related complications in both groups. CONCLUSION Compared with ultrasound-guided oblique subcostal TAPB, ultrasound-guided subcostal anterior QLB provided greater opioid-sparing effect, lower visual analogue scores, and shorter postoperative hospital stay for laparoscopic radical gastrectomy.
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Wang Y, Hu H, Feng C, Liu D, Ding N. Effect of Ultrasound-Guided Quadratus Lumborum Block Preemptive Analgesia on Postoperative Recovery of Patients with Open Radical Colon Cancer Surgery: A Retrospective Study. Cancer Manag Res 2021; 13:6859-6867. [PMID: 34512025 PMCID: PMC8420684 DOI: 10.2147/cmar.s322678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/21/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the effect of ultrasound-guided quadratus lumborum block (QLB) preemptive analgesia on recovery in colon cancer patients undergoing open radical surgery and provide reference for its clinical application. Methods From July 2019 to June 2020, according to the anesthesia method, 56 patients who received open radical colon surgery were divided into two groups: Group Q (n=27), which received QLB combined general anesthesia, and Group C (n=29), which received general anesthesia only. Both groups were given self-controlled intravenous analgesia pump after surgery. The primary outcome is a series of parameters representing postoperative recovery. The secondary outcome was VAS scores and opioid consumption. Results The first time of getting up, flatus, taking semi-liquid diet and the postoperative hospital stay in Group Q were significantly reduced (P<0.01). The rest and active VAS scores were significantly lower in Group Q (P<0.01). The opioids consumption was significantly decreased in Group Q (P<0.05). Conclusion The application of ultrasound-guided QLB preemptive analgesia in open radical colon cancer surgery can significantly enhance the postoperative analgesia effect, reduce opioid consumption, and accelerate the postoperative recovery of the patients. Clinical Trial Registration Number The Chinese Clinical Trial Registry (ChiCTR-2000034824).
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Affiliation(s)
- Ying Wang
- Department of Operation, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Hongping Hu
- Department of Anesthesiology, The Third People's Hospital of Liaocheng, Liaocheng, People's Republic of China
| | - Chang Feng
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Dongyi Liu
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Ning Ding
- Department of Outpatient, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
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Li XD, Li YJ, Fan CY. Efficacy and safety of ultrasound-guided quadratus lumborum block in patients receiving percutaneous nephrolithotomy under general anaesthesia. Int J Clin Pract 2021; 75:e14439. [PMID: 34092002 DOI: 10.1111/ijcp.14439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/03/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of this study was to explore the overall efficacy and safety of ultrasound-guided quadratus lumborum block combined with general anaesthesia in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS The study included 76 patients who underwent PCNL at our hospital between October 2018 and October 2019. The patients were randomly divided into the study group (ultrasound-guided quadratus lumborum block combined with general anaesthesia, 38 cases) and the control group (general anaesthesia, 38 cases). The intra-operative estimated blood loss, operative time and intra-operative anaesthetic usage were recorded. Moreover, the effective pressing times of the posterior cerebral artery (PCA) and the dosage of sufentanil in patient-controlled intravenous analgesia (PCIA) were observed within 48 hours after operation. RESULTS The dosage of propofol and remifentanil, the time of intestinal exhaust recovery time and the hospital study in the study group were lower than those in the control group. The HR and MAP of the two groups, with a trend towards gradual decrease at T0 and T1, were lower than those at T0. At 2, 6, 8 and 24 hours after operation, the visual analogue scale/score (VAS) of the study group was lower than that of the control group. The analgesic rescue rate, the dosage of sufentanil and the effective PCA compression times in the study group were lower than those in the control group. The total incidence of adverse reactions in postanaesthesia care unit in the study group was significantly lower than that in the control group (8/38 vs 18/38). CONCLUSION The combination of ultrasound-guided quadratus lumborum block and general anaesthesia effectively exerts beneficial outcomes in terms of validly reducing the dose of tranquilisers and anaesthetic analgesics during PCNL, which is able to treat patients with anaesthetic mode of low opioids.
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Affiliation(s)
- Xing-Da Li
- Department of Anesthesiology, Linyi Central Hospital, Linyi, Shandong, China
| | - Yu-Jian Li
- Department of Anesthesiology, Linyi Central Hospital, Linyi, Shandong, China
| | - Cheng-Yun Fan
- Department of Anesthesiology, Linyi Central Hospital, Linyi, Shandong, China
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Huang X, Sun Y, Shi R, Ma D, Wu A, Wang Y, Yang Y. Comparison of ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament with posterior quadratus lumborum block for perioperative analgesia in laparoscopic nephrectomy: a protocol for a randomised, prospective, parallel group, non-inferior trial. BMJ Open 2021; 11:e048490. [PMID: 34429312 PMCID: PMC8386232 DOI: 10.1136/bmjopen-2020-048490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Anterior quadratus lumborum block at the lateral supra-arcuate ligament (QLBA) is a new method for postoperative pain relief in patients undergoing abdominal surgery. Perioperative QLBA is effective, but it has not been compared with posterior quadratus lumborum block (QLB2). The present study aims to evaluate the postoperative pain of patients undergoing laparoscopic nephrectomy surgery with QLBA versus QLB2. METHODS/DESIGN This study is a randomised, prospective, parallel group, non-inferior trial. All patients undergoing laparoscopic nephrectomy surgery will be randomised 1:1 to the QLBA group or the QLB2 group with general anaesthesia. The objective of the trial is to evaluate the postoperative pain of patients undergoing laparoscopic nephrectomy surgery with QLBA (n=50) versus QLB2 (n=50). The primary outcome for this trial is the Visual Analogue Scale scores at rest and activity (dynamic pain scores are assessed with a cough or a trial to sit up in bed) 2 hours after surgery between patients who receive QLBA versus QLB2. The secondary objectives will be to compare (1) pain at rest and activity 0.5 hour, 2 hours, 24 hours, 48 hours after surgery; (2) the time spent on block operation; (3) the blocked dermatomal coverage 5 min and 15 min after block operation; (4) intraoperative opioid consumption; (5) types and doses of the rescue analgesic after surgery; (6) nausea and vomiting score within 24 hours after surgery; (7) time from the end of surgery to the first onset significant pain; (8) patient satisfaction score. DISCUSSION Clinical experience has supported that QLB is a very effective postoperative analgesic method, and we will answer the following questions in this trial: Will both approaches have the same analgesic effect and duration? Will the QLBA have a non-inferior postoperative analgesic effect compared with QLB2 or the QLBA be able to prolong the duration of analgesia after surgery? The results of this study could have actual clinical applications that could help to reduce postoperative pain and shorten hospital stays. ETHICS AND DISSEMINATION The study design was approved by the ethical committee of Beijing Chao-Yang Hospital, Beijing, China (2020-ke-321). The trial results will be published in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER ChiCTR2000035354.
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Affiliation(s)
- Xiao Huang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuan Sun
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Rong Shi
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Danxu Ma
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Anshi Wu
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yun Wang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yinan Yang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Chin KJ, Lirk P, Hollmann MW, Schwarz SKW. Mechanisms of action of fascial plane blocks: a narrative review. Reg Anesth Pain Med 2021; 46:618-628. [PMID: 34145073 DOI: 10.1136/rapm-2020-102305] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Fascial plane blocks (FPBs) target the space between two fasciae, rather than discrete peripheral nerves. Despite their popularity, their mechanisms of action remain controversial, particularly for erector spinae plane and quadratus lumborum blocks. OBJECTIVES This narrative review describes the scientific evidence underpinning proposed mechanisms of action, highlights existing knowledge gaps, and discusses implications for clinical practice and research. FINDINGS There are currently two plausible mechanisms of analgesia. The first is a local effect on nociceptors and neurons within the plane itself or within adjacent muscle and tissue compartments. Dispersion of local anesthetic occurs through bulk flow and diffusion, and the resulting conduction block is dictated by the mass of local anesthetic reaching these targets. The extent of spread, analgesia, and cutaneous sensory loss is variable and imperfectly correlated. Explanations include anatomical variation, factors governing fluid dispersion, and local anesthetic pharmacodynamics. The second is vascular absorption of local anesthetic and a systemic analgesic effect at distant sites. Direct evidence is presently lacking but preliminary data indicate that FPBs can produce transient elevations in plasma concentrations similar to intravenous lidocaine infusion. The relative contributions of these local and systemic effects remain uncertain. CONCLUSION Our current understanding of FPB mechanisms supports their demonstrated analgesic efficacy, but also highlights the unpredictability and variability that result from myriad factors at play. Potential strategies to improve efficacy include accurate deposition close to targets of interest, injections of sufficient volume to encourage physical spread by bulk flow, and manipulation of concentration to promote diffusion.
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Affiliation(s)
- Ki Jinn Chin
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Philipp Lirk
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam University Medical Centres, Amsterdam Medical Centre, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anaesthesiology (L·E·I·C·A), Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Stephan K W Schwarz
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
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Jadon A, Amir M, Sinha N, Chakraborty S, Ahmad A, Mukherjee S. Quadratus lumborum or transversus abdominis plane block for postoperative analgesia after cesarean: a double-blinded randomized trial. Braz J Anesthesiol 2021; 72:472-478. [PMID: 34246687 PMCID: PMC9373105 DOI: 10.1016/j.bjane.2021.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/13/2021] [Accepted: 06/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background Multimodal analgesia (MMA) is the current standard practice to provide post-cesarean analgesia. The aim of this study was to compare the analgesic efficacy of quadratus lumborum (QL) block and transversus abdominis plane (TAP) block as an adjunct to MMA. Methods Eighty mothers undergoing cesarean delivery under spinal anesthesia were randomized to receive either TAP or transmuscular QL block (QLB) with 20 mL 0.375% ropivacaine on each side. Postoperatively, all the subjects were assessed at 2, 4, 6, 8, 12, 18, and 24 hours. The primary outcome was the time to first analgesic request. The secondary outcomes were the pain scores during rest and movement, number of doses of tramadol, postoperative nausea-vomiting, sedation, and mother’s satisfaction with the pain management. Results The median (IQR) time to first analgesic request was 12 (9.25, 13) hours in the QL group and 9 (8.25, 11.37) hours in the TAP group (p = 0.0008). Patients in QL group consumed less doses of tramadol than those in TAP group (p < 0.0001). Pain scores were significantly lower in the QL group at all time points (p < 0.0001) except at 8th hour when at rest, p = 0.0024, and on movement, p = 0.0028. The maternal satisfaction was significantly higher in the QL group (p = 0.0017). Conclusion Our study showed the significant delay in time to first analgesic request in QL group patients. Patients in the QL group had lower pain scores, required fewer analgesic supplements, and had more satisfaction. Nausea-vomiting and sedation were comparable.
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Affiliation(s)
- Ashok Jadon
- Tata Motors Hospital, Department of Anesthesia & Pain Relief Service, Jamshedpur, India.
| | - Mohammad Amir
- Tata Motors Hospital, Department of Anesthesia & Pain Relief Service, Jamshedpur, India
| | - Neelam Sinha
- Tata Motors Hospital, Department of Anesthesia & Pain Relief Service, Jamshedpur, India
| | - Swastika Chakraborty
- Tata Motors Hospital, Department of Anesthesia & Pain Relief Service, Jamshedpur, India
| | - Asif Ahmad
- Tata Motors Hospital, Department of Anesthesia & Pain Relief Service, Jamshedpur, India
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Anterior Quadratus Lumborum Block Does Not Provide Superior Pain Control after Hip Arthroscopy: A Double-Blinded Randomized Controlled Trial. Anesthesiology 2021; 135:433-441. [PMID: 34237132 DOI: 10.1097/aln.0000000000003853] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hip arthroscopy is associated with moderate to severe postoperative pain. This prospective, randomized, double-blinded study investigates the clinically analgesic effect of anterior quadratus lumborum block with multimodal analgesia compared to multimodal analgesia alone. The authors hypothesized that an anterior quadratus lumborum block with multimodal analgesia would be superior for pain control. METHODS Ninety-six adult patients undergoing ambulatory hip arthroscopy were enrolled. Patients were randomized to either a single-shot anterior quadratus lumborum block (30 ml bupivacaine 0.5% with 2 mg preservative-free dexamethasone) or no block. All patients received neuraxial anesthesia, IV sedation, and multimodal analgesia (IV acetaminophen and ketorolac). The primary outcome was numerical rating scale pain scores at rest and movement at 30 min and 1, 2, 3, and 24 h. RESULTS Ninety-six patients were enrolled and included in the analysis. Anterior quadratus lumborum block with multimodal analgesia (overall treatment effect, marginal mean [standard error]: 4.4 [0.3]) was not superior to multimodal analgesia alone (overall treatment effect, marginal mean [standard error]: 3.7 [0.3]) in pain scores over the study period (treatment differences between no block and anterior quadratus lumborum block, 0.7 [95% CI, -0.1 to 1.5]; P = 0.059). Postanesthesia care unit antiemetic use, patient satisfaction, and opioid consumption for 0 to 24 h were not significantly different. There was no difference in quadriceps strength on the operative side between groups (differences in means, 1.9 [95% CI, -1.5 to 5.3]; P = 0.268). CONCLUSIONS Anterior quadratus lumborum block may not add to the benefits provided by multimodal analgesia alone after hip arthroscopy. Anterior quadratus lumborum block did not cause a motor deficit. The lack of treatment effect in this study demonstrates a surgical procedure without benefit from this novel block. EDITOR’S PERSPECTIVE
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Zanfini BA, Biancone M, Famele M, Catarci S, Lavalle R, Frassanito L, Piersanti A, Olivieri C, Lanzone A, Draisci R, Draisci G. Comparison of ropivacaine plasma concentration after posterior Quadratus Lumborum Block in Cesarean Section with ropivacaine with epinephrine vs plane. Minerva Anestesiol 2021; 87:979-986. [PMID: 33938678 DOI: 10.23736/s0375-9393.21.15354-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The posterior Quadratus Lumborum Block (pQLB) has been used in postoperative pain management after Cesarean Section (CS). However, clinicians have no data about pQLB safety in pregnants, at increased risk of local anesthetic systemic toxicity (LAST). The purpose of the present study was to explore the efficacy and the safety of adding epinephrine to ropivacaine for bilateral pQLB vs. bilateral pQLB performed with ropivacaine alone in CS. METHODS in this prospective trial 52 pregnants, ASA 2 physiological status, were consecutively allocated to one of 2 groups, e-pQLB and pQLB; e-pQLB group received 0.375% ropivacaine+100 mcg epinephrine, 20 ml each side; pQLB received 0.375% ropivacaine alone, 20 ml each side. The primary and secondary outcomes were to evaluate if the adjunct of epinephrine to ropivacaine increases efficacy and safety of pQLB, respectively. RESULTS Authors found in e-pQLB group vs. p-QLB group: a total mean morphine consumption statistically lower during the first 24 postoperative hours (5.08±3.12, vs 9.11±4.67 SD mg, p=0.0002); NRS values statistically lower at 6 hours from block, both at rest (1,73±1,88 SD vs. 2,88±2,53, p=0.03) and with movement (3,03±1,98 SD vs. 4,23±2,87, p=0.04); a longer time between block and the first opioid request (5.92±2.48 vs 3.78±2.68 SD hrs, p< 0.003); venous ropivacaine concentrations significantly lower at any time of samples but at 120 minutes. CONCLUSIONS Adding epinephrine to ropivacaine increases efficacy and duration of pQLB. Moreover it increases block safety, reducing peak and mean venous ropivacaine concentration.
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Affiliation(s)
- Bruno A Zanfini
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy -
| | - Matteo Biancone
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Famele
- National Institute of Health, National Center for Chemicals, Cosmetic Products and Consumer Health Protection, Rome, Italy
| | - Stefano Catarci
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberta Lavalle
- National Institute of Health, National Center for Chemicals, Cosmetic Products and Consumer Health Protection, Rome, Italy
| | - Luciano Frassanito
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandra Piersanti
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Cristina Olivieri
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonio Lanzone
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
| | - Rosa Draisci
- National Institute of Health, National Center for Chemicals, Cosmetic Products and Consumer Health Protection, Rome, Italy
| | - Gaetano Draisci
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
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Vamnes JS, Sørenstua M, Solbakk KI, Sterud B, Leonardsen AC. Anterior quadratus lumborum block for ambulatory laparoscopic cholecystectomy: a randomized controlled trial. Croat Med J 2021; 62:137-145. [PMID: 33938653 PMCID: PMC8107992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 01/31/2021] [Indexed: 04/03/2024] Open
Abstract
AIM To explore the effects of an anterior quadratus lumborum block (QLB) on opioid consumption, pain, nausea, and vomiting (PONV) after ambulatory laparoscopic cholecystectomy. METHODS This randomized controlled study recruited 70 patients scheduled for ambulatory laparoscopic cholecystectomy from January 2018 to March 2019. The participants were randomly allocated to one of the following groups: 1) anterior QLB (n=25) with preoperative ropivacaine 3.75 mg/mL, 20 mL bilaterally; 2) placebo QLB (n=22) with preoperative isotonic saline, 20 mL bilaterally; and 3) controls (n=23) given only standard intravenous and oral analgesia. The primary endpoint was opioid analgesic consumption. The secondary endpoints were pain (numeric rating scale 0-10) and PONV (scale 0-3, where 0=no PONV and 3=severe PONV). Assessments were made up to 48 hours postoperatively. RESULTS The groups did not significantly differ in opioids consumption and reported pain at 1, 2, 24, and 48 hours postoperatively. PONV in the QLB group was lower than in the placebo and control groups. CONCLUSION Preoperative anterior QLB for laparoscopic cholecystectomy did not affect postoperative opioid requirements and pain. However, anterior QLB may decrease PONV.
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Affiliation(s)
| | | | | | | | - Ann-Chatrin Leonardsen
- Ann-Chatrin Leonardsen, Østfold Hospital Trust, Postal box code 300, 1714 Grålum, Norway,
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Transversus abdominis plane block versus quadratus lumborum block type 2 for analgesia in renal transplantation: A randomised trial. Eur J Anaesthesiol 2021; 37:773-789. [PMID: 32175985 DOI: 10.1097/eja.0000000000001193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several studies have shown an analgesic efficacy of a transversus abdominis plane block (TAPB) in reducing opioid requirements during and after cadaveric renal transplantation surgery, but the effect of a quadratus lumborum block (QLB) in this type of surgery is unclear. OBJECTIVES The main objective of this prospective, randomised, double-centre clinical study was to compare the analgesic efficacy of a one-sided lateral approach TAPB with a unilateral QLB type 2 in cadaveric renal transplantation surgery. DESIGN Randomised, single-blinded trial. SETTING Two University-affiliated tertiary care hospitals between April 2016 and May 2017. PATIENTS A total of 101 patients aged more than 18 years, scheduled for cadaveric renal transplantation. INTERVENTIONS On receiving ethical board approval and individual informed consent, consecutive patients were allocated randomly to receive either an ultrasound-guided single-shot lateral TAPB or an ultrasound-guided single-shot QLB type 2 on the surgical side using 20 ml of bupivacaine 0.25% with adrenaline after a standardised induction of general anaesthesia. All patients on surgical completion and recovery from general anaesthesia were admitted to the postanaesthesia care unit for 24 h. They received standardised intravenous patient-controlled analgesia with fentanyl, and their pain scores were noted at regular intervals. MAIN OUTCOME MEASURES The primary endpoint was total cumulative fentanyl dose used per kg body mass in the first 24 h after surgery. Secondary outcomes were the need to start a continuous infusion of fentanyl in addition to patient-controlled analgesia boluses during the stay in post-anaesthesia care unit, postoperative pain severity measured using a numerical rating scale, patient satisfaction with analgesic treatment, evidence of postoperative nausea and vomiting, pruritus and sedation level. RESULTS The 49 patients allocated to the QLB type 2 group used significantly less fentanyl per kg in the first 24 h after surgery than the 52 patients who received a TAPB (median [IQR] 4.2 [2.3 to 8.0] μg kg versus 6.7 [3.5 to 10.7] μg kg, P = 0.042). No statistically significant differences were noted in the secondary endpoints within the study, including the frequency of adverse effects of opioids. CONCLUSION The reduction of fentanyl consumption in the first 24 h after renal transplantation with no difference in pain intensity and patient satisfaction shows a beneficial effect of one-sided QLB type 2 over a one-sided TAPB in regards to postoperative analgesia. However, the reduction in opioid consumption did not affect the frequency of opioid-related adverse effects. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02783586.
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