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Li W, Sun X, Hua Z, Yu T, Cao X, Liu P, Chen J, Bao J, Zhang H, Qu Z. Effect of postoperative intermittent boluses of subcostal quadratus lumborum block on pulmonary function recovery and analgesia after gastrectomy: a randomized controlled clinical trial. J Clin Anesth 2024; 95:111452. [PMID: 38581925 DOI: 10.1016/j.jclinane.2024.111452] [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: 02/27/2024] [Accepted: 03/20/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Following the gastrectomy, the reduction in pulmonary function is partly attributed to postoperative pain. Subcostal quadratus lumborum block (QLB) has recently emerged as a promising component in multimodal analgesia. We aimed to assess the impact of intermittent boluses of subcostal QLB on pulmonary function recovery and analgesic efficacy after gastrectomy. METHODS Sixty patients scheduled for gastrectomy were randomly assigned to either control group (multimodal analgesia) or intervention group (intermittent boluses of subcostal QLB plus multimodal analgesia). Two primary outcomes included the preservation of forced expiratory volume in the first second (FEV1) and the pain scores (0-10 cm visual analog score) on coughing 24 h postoperatively. We assessed the pulmonary function parameters, pain score, morphine consumption and number of rescue analgesia at a 24-h interval up to 72 h (Day1, Day2, Day3 respectively) as secondary outcomes. RESULTS 59 patients were analyzed in a modified intention-to-treat set. The preservation of FEV1 (median difference: 4.0%, 97.5% CI: -5.7 to 14.9, P = 0.332) and pain scores on coughing (mean difference: 0.0 cm, 97.5% CI: -1.1 to 1.2, P = 0.924) did not differ significantly between two groups. In the intervention group, the recovery of forced vital capacity (FVC) was faster 72 h after surgery (interaction effect of group*(Day3-Day0): estimated effect (β) =0.30 L, standard error (SE) =0.13, P = 0.025), pain scores at rest were lower in the first 3 days (interaction effect of group*(Day1-Day0): β = - 0.8 cm, SE = 0.4, P = 0.035; interaction effect of group*(Day2-Day0): β = - 1.0 cm, SE = 0.4, P = 0.014; and interaction effect of group*(Day3-Day0): β = - 1.0 cm, SE = 0.4, P values = 0.009 respectively), intravenous morphine consumption was lower during 0-24 h (median difference: -3 mg, 95% CI -6 to -1, P = 0.014) and in total 72 h (median difference: -5 mg, 95% CI -10 to -1, P = 0.019), and the numbers of rescue analgesia was fewer during 24-48 h (median difference: 0, 95% CI 0 to 0, P = 0.043). Other outcomes didn't show statistical differences. CONCLUSION Postoperative intermittent boluses of subcostal QLB did not confer advantages in terms of the preservation of FEV1 or pain scores on coughing 24 h after gastrectomy. However, notable effects were observed in analgesia at rest and FVC recovery.
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Affiliation(s)
- Wei Li
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Xiaolu Sun
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Zhen Hua
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Tao Yu
- Department of General Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Xianglong Cao
- Department of General Surgery, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Peng Liu
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Jing Chen
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Jie Bao
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Hongye Zhang
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Zongyang Qu
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China.
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Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022. World J Surg 2023; 47:11-34. [PMID: 36310325 PMCID: PMC9726826 DOI: 10.1007/s00268-022-06732-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) has been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016. The aim of the present article was to update the ERAS guidelines in liver surgery using a modified Delphi method based on a systematic review of the literature. METHODS A systematic literature review was performed using MEDLINE/PubMed, Embase, and the Cochrane Library. A modified Delphi method including 15 international experts was used. Consensus was judged to be reached when >80% of the experts agreed on the recommended items. Recommendations were based on the Grading of Recommendations, Assessment, Development and Evaluations system. RESULTS A total of 7541 manuscripts were screened, and 240 articles were finally included. Twenty-five recommendation items were elaborated. All of them obtained consensus (>80% agreement) after 3 Delphi rounds. Nine items (36%) had a high level of evidence and 16 (64%) a strong recommendation grade. Compared to the first ERAS guidelines published, 3 novel items were introduced: prehabilitation in high-risk patients, preoperative biliary drainage in cholestatic liver, and preoperative smoking and alcohol cessation at least 4 weeks before hepatectomy. CONCLUSIONS These guidelines based on the best available evidence allow standardization of the perioperative management of patients undergoing liver surgery. Specific studies on hepatectomy in cirrhotic patients following an ERAS program are still needed.
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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
- Correspondence: Ming Yan, Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, 221000, People’s Republic of China, Tel +86 18052268329, Email
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Araújo KMD, Ferraro LHC, Sun SY, Mattar R. Randomized Clinical Trial Comparing Quadratus Lumborum Block and Intrathecal Morphine for Postcesarean Analgesia. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1083-1089. [PMID: 36580935 PMCID: PMC9800151 DOI: 10.1055/s-0042-1759728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare the efficacy of quadratus lumborum (QL) block and intrathecal morphine (M) for postcesarean delivery analgesia. METHODS Thirty-one pregnant women with ≥ 37 weeks of gestation submitted to elective cesarean section were included in the study. They were randomly allocated to either the QL group (12.5 mg 0.5% bupivacaine for spinal anesthesia and 0.3 ml/kg 0.2% bupivacaine for QL block) or the M group (12.5 mg bupivacaine 0.5% and 100 mcg of morphine in spinal anesthesia). The visual analog scale of pain, consumption of morphine and tramadol for pain relief in 48 hours, and side effects were recorded. RESULTS Median pain score and/or pain variation were higher in the morphine group than in the QL group (p = 0.02). There was no significant difference in the consumption of morphine or tramadol between groups over time. Side effects such as pruritus, nausea, and vomiting were observed only in the morphine group. CONCLUSION Quadratus lumborum block and intrathecal morphine are effective for analgesia after cesarean section. Patients undergoing QL block had lower postoperative pain scores without the undesirable side effects of opioids such as nausea, vomiting, and pruritus.
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Affiliation(s)
- Karoline Moura de Araújo
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil,Address for correspondence Karoline Moura de Araújo Escola Paulista de Medicina, Universidade Federal de São PauloRua Napoleão de Barros, 715, 04024002, São Paulo, SPBrazil
| | | | - Sue Yasaki Sun
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rosiane Mattar
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Analgesic Effect of Ultrasound-Guided Anterior Quadratus Lumborum Block at the L2 Level in Patients Undergoing Laparoscopic Partial Nephrectomy: A Single-Center, Randomized Controlled Trial. Pain Res Manag 2022; 2022:8958859. [PMID: 36569463 PMCID: PMC9779996 DOI: 10.1155/2022/8958859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
Objectives This study aimed to evaluate the effect of ultrasound-guided anterior quadratus lumborum block (QLB) at the L2 level in patients undergoing laparoscopic partial nephrectomy. Methods Patients who were 18-70 years old with an American Society of Anesthesiologists (ASA) physical status of 1-2 and were scheduled for elective laparoscopic partial nephrectomy were recruited into the cluster randomized controlled trial. Sixty-three patients were randomly allocated to receive QLB (group Q, n = 32) or no block (group C, n = 31). The patients were not masked to the group allocations. The postoperative follower was blinded to the group allocations. All patients received total intravenous anesthesia, the same multimodal analgesic regimen, and rescue analgesia when needed. The primary outcome was perioperative cumulative sufentanil consumption. Results 30 patients in group Q and 29 patients in group C were included in the statistical analysis. Block-related complications were not found in this study. Sufentanil consumption during the perioperative period (155.41 [19.58] vs 119.37 [12.41] μg, p < 0.001) and sufentanil dosage during surgery and 0-6 h, 6-12 h, and 12-24 h after surgery were lower in group Q than in group C, while 24-48 h after surgery was similar between both groups. The median sensory blockade area in group Q was T9-L1. Comparison of invasive blood pressure (BP) and heart rate (HR) before and after skin incision in group C was statistically significant, but there was no significant difference in group Q. Both at rest and during activity, numerical rating scale (NRS) scores and the incidence of rescue analgesia were lower in group Q at any time point after surgery. The incidences of postoperative nausea and vomiting (PONV), time from postoperative to discharge, postoperative recovery quality, or anesthesia satisfaction were similar between the two groups. Conclusions Anterior QLB at the L2 level can reduce the perioperative dosage of sufentanil and the degree of postoperative pain in patients undergoing laparoscopic partial nephrectomy, but it did not improve postoperative recovery quality and anesthesia satisfaction.
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Marchina-Gonçalves A, Gil F, Laredo FG, Soler M, Agut A, Belda E. Evaluation of High-Volume Injections Using a Modified Dorsal Quadratus Lumborum Block Approach in Canine Cadavers. Animals (Basel) 2021; 12:ani12010018. [PMID: 35011124 PMCID: PMC8749509 DOI: 10.3390/ani12010018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/10/2021] [Accepted: 12/19/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The quadratus lumborum (QL) block is an ultrasound-guided locoregional anesthesia technique. Its objective is to promote both visceral and somatic analgesia for abdominal procedures. Previous spread studies carried out in canine cadavers demonstrated its viability in this species but failed in consistently reach the spinal nerves responsible for the cranial abdominal wall innervation. Therefore, we hypothesize that a modified QL block technique, based on the administration of a higher volume of solution (0.6 mL kg−1) in a dorso-medial position compared to the interfascial injection point between the QL and psoas minor muscles, could enhance its cranial spread, and promote a consistent distribution spread through the ventral branches of the spinal nerves and sympathetic trunk. For this purpose, a solution of dye/contrast was ultrasound-guide injected into six canine cadavers. The results were assessed through computed tomography and dissection, showing that the proposed technique is viable, safe, and stained the median and caudal abdominal nerves and the sympathetic trunk up to T13 consistently. However, our modified technique of QL block did not increase the cranial distribution of dye/contrast to the thoracic spinal nerves, and may not provide adequate somatic analgesia of the cranial abdominal wall. Abstract The quadratus lumborum (QL) block targets the fascial plane surrounding the QL muscle providing abdominal somatic and visceral analgesia. The extension of its analgesic effects is a subject of research, as it could not cover areas of the cranial abdomen in dogs. This study assesses in eight thawed canine cadavers, the distribution of high-volume injections (0.6 mL kg−1 of a mixture of methylene blue and iopromide) injected between the psoas minor muscle and the vertebral body of L1. Anatomical features of the area of interest were studied in two cadavers. In another six dogs, QL blocks were performed bilaterally under ultrasound-guidance. The distribution of contrast was evaluated by computed tomography (CT). Hypaxial abdominal muscles were dissected to visualize the dye spread (spinal nerves and sympathetic trunk) in 5 cadavers. The remaining cadaver was refrozen and cross-sectioned. CT studies showed a maximum distribution of contrast from T10 to L7. The methylene blue stained T13 (10%), L1 (100%), L2 (100%), L3 (100%), L4 (60%) and the sympathetic trunk T10 (10%), T11 (20%), T12 (30%), T13 (70%), L1 (80%), L2 (80%), L3 (60%) and L4 (30%). These findings may suggest that despite the high volume of injectate administered, this modified QL block could not produce somatic analgesia of the cranial abdomen, although it could provide visceral analgesia in dogs.
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Affiliation(s)
- André Marchina-Gonçalves
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (A.M.-G.); (F.G.L.); (M.S.); (A.A.)
| | - Francisco Gil
- Departamento de Anatomía y Embriología Veterinaria, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain;
| | - Francisco G. Laredo
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (A.M.-G.); (F.G.L.); (M.S.); (A.A.)
| | - Marta Soler
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (A.M.-G.); (F.G.L.); (M.S.); (A.A.)
| | - Amalia Agut
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (A.M.-G.); (F.G.L.); (M.S.); (A.A.)
| | - Eliseo Belda
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad de Murcia, 30100 Murcia, Spain; (A.M.-G.); (F.G.L.); (M.S.); (A.A.)
- Correspondence:
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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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Evaluation of Quadratus Lumborum Block as Part of an Opioid-Free Anaesthesia for Canine Ovariohysterectomy. Animals (Basel) 2021; 11:ani11123424. [PMID: 34944201 PMCID: PMC8697988 DOI: 10.3390/ani11123424] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The aim of this study was to assess an anaesthetic protocol involving the quadratus lumborum block (QLB) for canine ovariohysterectomy. Ten healthy dogs were included. Anaesthetic protocol consisted of medetomidine and meloxicam, induction of anaesthesia with propofol and maintenance with sevoflurane in oxygen/medical air. The QLB was performed at the level of L1–L2 injecting 0.4 mL kg−1 of 0.25% bupivacaine/iohexol per side. Computed Tomography (CT) was performed before and after surgery. Fentanyl was administered as rescue analgesia during surgery. The Short Form of The Glasgow Composite Pain Scale and thermal threshold (TT) at the level of the humerus, T10, T13 and L3 were assessed before premedication and every hour postoperatively. Methadone was given as rescue analgesia when it was needed. CT images showed spreading of a median (range) of 3 (2–5) vertebrae, without differences between preoperative and postoperative images. One out of ten dogs needed intraoperative rescue analgesia. Pain score was less than 4/24 in all the animals until four hours after surgery. TT showed significative increase in all the areas tested apart from the elbow 30 min after the recovery. The QLB provides additional analgesia for canine ovariohysterectomy. Abstract Quadratus lumborum block (QLB) is used to provide analgesia for abdominal surgery in humans. The aim of this study was to assess an anaesthetic protocol involving the QLB for canine ovariohysterectomy. Ten dogs were included. Anaesthetic protocol consisted of premedication with IM medetomidine (20 μg kg−1) and SC meloxicam (0.1 mg kg−1), induction with propofol to effect, and maintenance with sevoflurane in oxygen/medical air. QLB was performed injecting 0.4 mL kg−1 of 0.25% bupivacaine/iohexol per side. Computed Tomography (CT) was performed before and after surgery. Fentanyl was administered as rescue analgesia during surgery. The Short Form of The Glasgow Composite Pain Scale and thermal threshold (TT) at the level of the elbow, T10, T13 and L3 were assessed before premedication and every hour postoperatively. Methadone was given as rescue analgesia postoperatively when pain score was >3. A Yuen’s test on trimmed means for dependent samples was used to analyse the data (p < 0.05). CT images showed spreading of the contrast/block for a median (range) of 3 (2–5) vertebrae, without differences between preoperative and postoperative images. One dog needed rescue analgesia during surgery. Pain score was less than 4/24 in all the animals during the first 4 h after surgery. TT showed a significant increased signal in all the areas tested, apart from the humerus, 30 min after surgery. The QLB may provide additional analgesia for canine ovariohysterectomy. Further studies are needed to assess the specific contribution of the QLB in abdominal analgesia.
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Dudek P, Zawadka M, Andruszkiewicz P, Gelo R, Pugliese F, Bilotta F. Postoperative Analgesia after Open Liver Surgery: Systematic Review of Clinical Evidence. J Clin Med 2021; 10:jcm10163662. [PMID: 34441958 PMCID: PMC8397227 DOI: 10.3390/jcm10163662] [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: 06/13/2021] [Revised: 08/07/2021] [Accepted: 08/13/2021] [Indexed: 12/17/2022] Open
Abstract
Background: The existing recommendations for after open liver surgery, published in 2019, contains limited evidence on the use of regional analgesia techniques. The aim of this systematic review is to summarize available clinical evidence, published after September 2013, on systemic or blended postoperative analgesia for the prevention or treatment of postoperative pain after open liver surgery. Methods: The PUBMED and EMBASE registries were used for the literature search to identify suitable studies. Keywords for the literature search were selected, with the authors’ agreement, using the PICOS approach: participants, interventions, comparisons, outcomes, and study design. Results: The literature search led to the retrieval of a total of 800 studies. A total of 36 studies including 25 RCTs, 5 prospective observational, and 7 retrospective observational studies were selected as suitable for this systematic review. Conclusions: The current evidence suggests that, in these patients, optimal postoperative pain management should rely on using a “blended approach” which includes the use of systemic opioids and the infusion of NSAIDs along with regional techniques. This approach warrants the highest efficacy in terms of pain prevention, including the lower incretion of postoperative “stress hormones”, and fewer side effects. Furthermore, concerns about the potential for the increased risk of wound infection related to the use of regional techniques have been ruled out.
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Affiliation(s)
- Paula Dudek
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Warsaw, 02-097 Warsaw, Poland; (P.D.); (P.A.); (R.G.)
| | - Mateusz Zawadka
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Warsaw, 02-097 Warsaw, Poland; (P.D.); (P.A.); (R.G.)
- Perioperative Medicine, Barts Heart Centre and St. Bartholomew’s Hospital, London EC1A 7BE, UK
- Correspondence:
| | - Paweł Andruszkiewicz
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Warsaw, 02-097 Warsaw, Poland; (P.D.); (P.A.); (R.G.)
| | - Remigiusz Gelo
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Warsaw, 02-097 Warsaw, Poland; (P.D.); (P.A.); (R.G.)
| | - Francesco Pugliese
- Department of Anesthesiology and Critical Care, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy; (F.P.); (F.B.)
| | - Federico Bilotta
- Department of Anesthesiology and Critical Care, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy; (F.P.); (F.B.)
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Little C, Rahman S. Quadratus Lumborum Blocks in Nephrectomy: A Narrative Review. Local Reg Anesth 2021; 14:57-65. [PMID: 33907461 PMCID: PMC8064613 DOI: 10.2147/lra.s290224] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
The quadratus lumborum block is a novel truncal block where local anaesthetic is injected adjacent to the quadratus lumborum muscle. It is used for caesarean sections, hip arthroplasty, gynecologic surgery, colectomy, and recently nephrectomy. To date, there are no reviews that outline the efficacy and performance of the quadratus lumborum blocks in patients receiving laparoscopic nephrectomy. The objective of this project was to outline the current available data from both clinical trials along with case series and reports regarding the methods and utility of quadratus lumborum blocks for analgesia in patients receiving nephrectomy. For this literature review, we searched Pubmed, Embase, and Web of Science from their inception until 5/31/2020. Our search terms were as follows: “(nephrectomy OR laparoscopic nephrectomy) AND (QL block OR Quadratus Lumborum block OR QL OR TQL OR Thoracolumbar fascia block).” We analyzed all relevant clinical trials for quality using the Jadad scale. Our search yielded a total of 30 articles, 23 of which we ultimately reviewed for this manuscript. The qualitative sum of these data show that patients receiving quadratus lumborum block for nephrectomies have reduced opioid requirements, reduced pain scores, and improved side-effects relative to other analgesic modalities like epidurals. Based on these findings, we conclude that the quadratus lumborum block is a useful analgesic for patients undergoing nephrectomy.
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Affiliation(s)
- Christopher Little
- Department of Anesthesiology and Perioperative Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Siamak Rahman
- Department of Anesthesiology and Perioperative Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
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Wang D, He Y, Chen X, Lin Y, Liu Y, Yu Z. Ultrasound guided lateral quadratus lumborum block enhanced recovery in patients undergoing laparoscopic colorectal surgery. Adv Med Sci 2021; 66:41-45. [PMID: 33359908 DOI: 10.1016/j.advms.2020.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/04/2020] [Accepted: 12/10/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE This study aimed to evaluate the effects of lateral quadratus lumborum block (QLB) on postoperative pain and recovery in patients undergoing laparoscopic colorectal surgery. MATERIALS AND METHODS Patients between 18 and 70 years old, diagnosed with colon or rectal cancer, with American Society of Anesthesiologists (ASA) physical status I or II, and scheduled for laparoscopic colorectal surgery were recruited. Patients were excluded if they were allergic to local anesthetics and unable to complete the procedure of puncture or follow-up evaluation. All included patients were randomly allocated to either QLB or Sham group. The primary outcome was perioperative cumulative sufentanil consumption. RESULTS There were no significant differences between the groups in anesthetic time, operation time, dosage of propofol, and remifentanil (P > 0.05). Patients in the QLB group had significantly less sufentanil consumption both intraoperatively and postoperatively, compared with the Sham group (P < 0.05). Postoperative VAS pain scores on coughing in the QLB group at 2 h, 6 h, 12 h, 24 h time points and VAS pain score at rest 2 h, 6 h after surgery were significantly lower than in the Sham group (P < 0.05). Compared with the Sham group, time to first ambulation and anal flatus after surgery in the QLB group were significantly shorter (P < 0.05). Significant differences of postoperative rescue analgesic usage and QoR-15 score at 48 h were found between the two groups (P < 0.05). CONCLUSIONS Ultrasound-guided lateral QLB significantly reduced perioperative opioid consumption, alleviated postoperative pain, shortened the time to first ambulation and anal flatus, and enhanced postoperative recovery of the patients undergoing laparoscopic colorectal surgery.
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Affiliation(s)
- Danfeng Wang
- Department of Anesthesiology, Fujian Provincial Medical College, Fujian Medical University, Fuzhou, China; Division of Anesthesia, Fujian Provincial Hospital, Fuzhou, China
| | - Ying He
- Department of Anesthesiology, Fujian Provincial Medical College, Fujian Medical University, Fuzhou, China
| | - Xiaohui Chen
- Department of Anesthesiology, Fujian Provincial Medical College, Fujian Medical University, Fuzhou, China; Division of Anesthesia, Fujian Provincial Hospital, Fuzhou, China
| | - Yanling Lin
- Division of Anesthesia, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yanjie Liu
- Division of Anesthesia, Fujian Provincial Hospital, Fuzhou, China
| | - Zenggui Yu
- Department of Anesthesiology, Fujian Provincial Medical College, Fujian Medical University, Fuzhou, China; Division of Anesthesia, Fujian Provincial Hospital, Fuzhou, China.
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Pang M, Sun G, Yao W, Zhou S, Shen N, Liao H, Xie H, Gao W, Ge M. Ultrasound-guided transmuscular quadratus lumborum block reduced postoperative opioids consumptions in patients after laparoscopic hepatectomy: a three-arm randomized controlled trial. BMC Anesthesiol 2021; 21:45. [PMID: 33573598 PMCID: PMC7877010 DOI: 10.1186/s12871-021-01255-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/12/2021] [Indexed: 12/17/2022] Open
Abstract
Background To investigate whether transmuscular quadratus lumborum block (TQLB) combined with oxycodone-based patient-controlled intravenous analgesia (PCIA) compared with sufentanil-based patient-controlled intravenous analgesia could reduce postoperative pain and opioid consumption in patients undergoing laparoscopic hepatectomy. Methods Eighty patients undergoing laparoscopic hepatectomy surgery were randomly divided into Group S (Sufentanil for PCIA group), Group O (Oxycodone for PCIA group) and Group QO (transmuscular quadratus lumborum block + oxycodone for PCIA group). Primary outcome was Numerical Rating Scale (NRS) pain score when coughing at 6th hour after the operation. We summarized opioid consumption and recorded complications, opioid drug adverse reaction and analgesia satisfaction. Results NRS pain scores were significantly lower in Group QO while patients coughing at 6th hour after the operation compared with Group S and Group O (median (interquartile range [IQR]):Group S vs. Group O vs. Group QO 4.0 [3.0, 5.0] vs. 4.0[3.0,5.0]vs.3.0 [2.0, 3.0], p < 0.05). Within 24 h after surgery, the bolus times of PCIA (patient controlled intravenous analgesia) in the QO group was reduced which was compared with the Group S and Group O (median (interquartile range [IQR]):Group S vs. Group O vs. Group QO 13.0 [10.3, 19.5] vs. 11.5 [7.8, 18.3]vs.6.5[3.5,12.0], p < 0.05). The proportion of patients in the three groups who required additional analgesia was ranked as Group QO < Group O < Group S(p < 0.05). The analgesic satisfaction of patients in Group QO was higher than the Group S (p = 0.001) and Group O (p = 0.012). Conclusions TQLB combined with oxycodone-based PCIA provided satisfactory postoperative analgesia and reduced oxycodone consumption in patients following laparoscopic hepatectomy. Trial registration ChiCTR1900028467 (22/12/2019). Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01255-3.
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Affiliation(s)
- Mengya Pang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou City, 510630, Guangdong Province, China
| | - Guoliang Sun
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou City, 510630, Guangdong Province, China
| | - Weifeng Yao
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou City, 510630, Guangdong Province, China
| | - Shaoli Zhou
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou City, 510630, Guangdong Province, China
| | - Ning Shen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou City, 510630, Guangdong Province, China
| | - Haofeng Liao
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou City, 510630, Guangdong Province, China
| | - Hanbing Xie
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou City, 510630, Guangdong Province, China
| | - Wanling Gao
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou City, 510630, Guangdong Province, China.
| | - Mian Ge
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou City, 510630, Guangdong Province, China.
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Dieu A, Huynen P, Lavand'homme P, Beloeil H, Freys SM, Pogatzki-Zahn EM, Joshi GP, Van de Velde M. Pain management after open liver resection: Procedure-Specific Postoperative Pain Management (PROSPECT) recommendations. Reg Anesth Pain Med 2021; 46:433-445. [PMID: 33436442 PMCID: PMC8070600 DOI: 10.1136/rapm-2020-101933] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/20/2020] [Accepted: 12/22/2020] [Indexed: 02/07/2023]
Abstract
Background and objectives Effective pain control improves postoperative rehabilitation and enhances recovery. The aim of this review was to evaluate the available evidence and to develop recommendations for optimal pain management after open liver resection using Procedure-Specific Postoperative Pain Management (PROSPECT) methodology. Strategy and selection criteria Randomized controlled trials (RCTs) published in the English language from January 2010 to October 2019 assessing pain after liver resection using analgesic, anesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane databases. Results Of 121 eligible studies identified, 31 RCTs and 3 systematic reviews met the inclusion criteria. Preoperative and intraoperative interventions that improved postoperative pain relief were non-steroidal anti-inflammatory drugs, continuous thoracic epidural analgesia, and subcostal transversus abdominis plane (TAP) blocks. Limited procedure-specific evidence was found for intravenous dexmedetomidine, intravenous magnesium, intrathecal morphine, quadratus lumborum blocks, paravertebral nerve blocks, continuous local anesthetic wound infiltration and postoperative interpleural local anesthesia. No evidence was found for intravenous lidocaine, ketamine, dexamethasone and gabapentinoids. Conclusions Based on the results of this review, we suggest an analgesic strategy for open liver resection, including acetaminophen and non-steroidal anti-inflammatory drugs, combined with thoracic epidural analgesia or bilateral oblique subcostal TAP blocks. Systemic opioids should be considered as rescue analgesics. Further high-quality RCTs are needed to confirm and clarify the efficacy of the recommended analgesic regimen in the context of an enhanced recovery program.
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Affiliation(s)
- Audrey Dieu
- Department of Anesthesiology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Philippe Huynen
- Department of Cardiovascular Sciences, KULeuven, Leuven, Belgium
| | - Patricia Lavand'homme
- Department of Anesthesiology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Hélène Beloeil
- Anesthesia and Intensive Care Department, University of Rennes, CHU Rennes, Inserm, INRA, CIC 1414 NuMeCan, Rennes, France
| | - Stephan M Freys
- Department of Surgery, DIAKO Ev. Diakonie-Krankenhaus, Bremen, Germany
| | - Esther M Pogatzki-Zahn
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Marc Van de Velde
- Department of Cardiovascular Sciences, KULeuven, Leuven, Belgium.,Department of Anesthesiology, UZ Leuven, Leuven, Belgium
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FernÁndez MT, LÓpez S, Aguirre JA, AndrÉs J, Ortigosa E. Serratus intercostal interfascial plane block in supraumbilical surgery: a prospective randomized comparison. Minerva Anestesiol 2020; 87:165-173. [PMID: 33319949 DOI: 10.23736/s0375-9393.20.14882-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Upper abdominal wall surgical incisions may lead to a severe postoperative pain. Therefore, adequate analgesia is important. Here we investigate whether the low serratus-intercostal interfascial plane block (SIPB) achieves an effective analgesia, considering opioids consumption, pain control and recovery quality in upper abdominal surgeries. METHODS This blinded, randomized controlled study was conducted on 102 patients undergoing open upper abdominal wall surgery under general anesthesia. All patients who received serratus-intercostal plane block at the eighth rib as analgesic technique were included in SIPB group and in control group those who received continuous intravenous morphine analgesia. Pain scores in numeric verbal scale (NVS) and opioids consumption at 0, 6, 12, 24 and 48 hours postoperatively were assessed. The quality of the postoperative recovery was evaluated using the QoR-15 questionnaire at 24 hours. RESULTS This study showed lower postoperative opioid consumption at 24 hours (P<0.0001; 4.17 mg vs. 41.52 mg of morphine) and better pain control (P<0.005) with mean pain scores (NVS 1.8±1.5 vs. 4.8±1.6) in group 0 (SIPB). The global QoR-15 scores 24 hours postoperatively were higher (better quality) in the SIPB group (122 vs. 100). CONCLUSIONS The low serratus-intercostal interfascial plane block (SIPB) provides efficient analgesia leading to a saving of opioids and improvement of the recovery quality in patients undergoing upper abdominal wall surgeries.
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Affiliation(s)
- María T FernÁndez
- Department of Anesthesiology, Rio Hortega University Hospital, Valladolid, Spain -
| | - Servando LÓpez
- Department of Anesthesiology, Abente y Lago Hospital, A Coruña, Spain
| | - Jose A Aguirre
- Department of Anesthesiology, Intensive Care and Pain Medicine, Balgrist University Hospital, Zürich, Switzerland
| | - Judith AndrÉs
- Department of Anesthesiology, Rio Hortega University Hospital, Valladolid, Spain
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Rohan VS, Taber DJ, Patel N, Perez C, Pilch N, Parks S, Bolin E, Nadig SN, Baliga PK, Fleming JN. Impact of a multidisciplinary multimodal opioid minimization initiative in kidney transplant recipients. Clin Transplant 2020; 34:e14006. [DOI: 10.1111/ctr.14006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Vinayak S. Rohan
- Division of Transplant Surgery Department of Surgery Medical University of South Carolina Charleston SC USA
| | - David J. Taber
- Division of Transplant Surgery Department of Surgery Medical University of South Carolina Charleston SC USA
| | - Neha Patel
- Department of Pharmacy Medical University of South Carolina Charleston SC USA
| | - Caroline Perez
- Department of Pharmacy Medical University of South Carolina Charleston SC USA
| | - Nicole Pilch
- Department of Pharmacy Medical University of South Carolina Charleston SC USA
| | - Sara Parks
- Department of Nursing Medical University of South Carolina Charleston SC USA
| | - Eric Bolin
- Department of Anesthesia Medical University of South Carolina Charleston SC USA
| | - Satish N. Nadig
- Division of Transplant Surgery Department of Surgery Medical University of South Carolina Charleston SC USA
| | - Prabhakar K. Baliga
- Division of Transplant Surgery Department of Surgery Medical University of South Carolina Charleston SC USA
| | - James N. Fleming
- Department of Pharmacy Medical University of South Carolina Charleston SC USA
- Care Dx Inc Brisbane CA USA
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Chen L, Ji J, Tian Y, Sun Q, Qiu X, Li X, Li B. Retrospective study of quadratus lumborum block for postoperative analgesia in patients undergoing percutaneous nephrolithotomy. BMC Anesthesiol 2020; 20:217. [PMID: 32867683 PMCID: PMC7457541 DOI: 10.1186/s12871-020-01134-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background The postoperative analgesic effect of transmuscular quadratus lumborum block (QLB-TM) in patients following lower abdominal surgeries has been identified; however, the efficacy of QLB using the lateral approach (QLB-L) is still in debate. Therefore, this retrospective study was conducted to investigate the effect of a single-shot block with QLB-L on postoperative analgesia for patients undergoing percutaneous nephrolithotomy (PCNL). Methods The medical information of the patients undergoing PCNL was retrieved from the electronic charter system (Medisystem, Suzhou, China) in our Nanjing Drum Tower Hospital during the period of Jan/2019 to Jun/2019. Among the total of 57 patients, there are 17, 18, and 22 patients subjected to QLB-L, QLB-TM, or routine treatment, respectively. The primary observational parameter was to assess postoperative pain with visual analog scales (VAS) at rest 30 min after extubation, 24 h, and 48 h after surgery, respectively. The secondary observatory endpoints, including the consumption of intraoperative opioids, the cumulative dose of non-steroid anti-inflammatory drugs (NSAIDs) and the incidence of adverse events related to postoperative analgesia, were evaluated as well. Results The static VAS score at 24 h after surgery and the intraoperative consumption of sufentanil were significantly lower in patients receiving either intervention of QLB-L or QLB-TM as compared with those receiving routine treatment. However, one shot of QLB had no impact on VAS scores at 30 min post-extubation, 48 h after PCNL procedure compared with the patients receiving routine treatment. The percentage of non-ambulatory patients within 24 h post-PCNL was significantly higher in the QLB-TM group compared with the routine treatment group (P = 0.04). There were no significant differences in the incidence of postoperative nausea and vomit (PONV), itches, respiratory depression, the time for the first defecation, and the length of hospital stay (LOS) among the three groups. Conclusions QLB-L procedure may exert as equivalent as QLB-TM in terms of abrogating postoperative pain within 24 h post-surgery and decreasing intraoperative sufentanil consumption in patients undergoing PCNL procedure as well. The caution should be taken to avoid lower extremities weakness in the patients after QLB-TM within the first 24 h post-PCNL procedure.
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Affiliation(s)
- Luning Chen
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Jingjing Ji
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Yali Tian
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Qing Sun
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Xuefeng Qiu
- Department of Surgery, Urology Surgery, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Xiaogong Li
- Department of Surgery, Urology Surgery, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China
| | - Bingbing Li
- Department of Anesthesiology, Drum Tower Hospital Affiliated Nanjing University Medical School, Road 321#, Nanjing, Zhongshan, 210008, China.
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Sindwani G, Sahu S, Suri A, Sureka S, Thomas M. Efficacy of ultrasound guided quadratus lumborum block as postoperative analgesia in renal transplantation recipients: A randomised double blind clinical study. Indian J Anaesth 2020; 64:605-610. [PMID: 32792737 PMCID: PMC7413355 DOI: 10.4103/ija.ija_21_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/23/2020] [Accepted: 05/04/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Postoperative pain following renal transplantation is moderate to severe. Quadratus lumborum block (QLB) is a new block that can provide effective analgesia following abdominal and retroperitoneal surgeries. This study aimed to evaluate the analgesic efficacy of QLB for postoperative analgesia in patients undergoing renal transplantation. Methods Patients were randomised into two groups of 30 each. In group A (block group), 20 mL of 0.25% bupivacaine and group B (placebo group), 20 mLof normal saline were injected. In the postoperative room, an intravenous patient controlled analgesia (IVPCA) pump with fentanyl was started in both the group. The postoperatively recorded parameters were numerical rating scale (NRS) pain score at rest and on movement and coughing, total fentanyl consumption, sedation score, postoperative nausea vomiting, limb weakness, paralytic ileus, and any other block-related complication. Data were analysed using SPSS software version 22.0. Categorical data were analysed using the Chi-square method. Student t test or Mann-Whitney U test was applied for the continuous data. Numerical data with normal distribution were displayed as mean (standard deviation), abnormal distribution was displayed in the median (interquartile range) values, and as a percentage for categorical variables. Results Fentanyl consumption, numerical rating score, and sedation score were significantly less in group A when compared to group B at 1, 4, 8, 12, and 24 h (P < 0.001). Conclusion Type-1 QLB significantly reduces fentanyl consumption and NRS pain score at 1,4,8,12, and 24 h in the postoperative period in renal transplant recipients.
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Affiliation(s)
| | - Sandeep Sahu
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Aditi Suri
- Department of Oncoanesthesia, AIIMS, New Delhi, India
| | - Sanjoy Sureka
- Department of Urology and Renal Transplantation, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Manu Thomas
- Department of Anaesthesiology, ILBS, New Delhi, India
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Kim SH, Kim HJ, Kim N, Lee B, Song J, Choi YS. Effectiveness of quadratus lumborum block for postoperative pain: a systematic review and meta-analysis. Minerva Anestesiol 2020; 86:554-564. [DOI: 10.23736/s0375-9393.20.13975-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Aoyama Y, Sakura S, Wittayapairoj A, Abe S, Tadenuma S, Saito Y. Continuous basal infusion versus programmed intermittent bolus for quadratus lumborum block after laparoscopic colorectal surgery: a randomized-controlled, double-blind study. J Anesth 2020; 34:642-649. [DOI: 10.1007/s00540-020-02791-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/09/2020] [Indexed: 12/21/2022]
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Wang Y, Wang X, Zhang K. Effects of transversus abdominis plane block versus quadratus lumborum block on postoperative analgesia: a meta-analysis of randomized controlled trials. BMC Anesthesiol 2020; 20:103. [PMID: 32366275 PMCID: PMC7199334 DOI: 10.1186/s12871-020-01000-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 04/01/2020] [Indexed: 02/08/2023] Open
Abstract
Background Trunk block technique has been used in postoperative analgesia for patients undergoing surgery, specifically, transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) have been proved effective. The purpose of this meta-analysis is to evaluate the effects of TAPB and QLB in postoperative analgesia. Methods Online databases, including MEDLINE, EMBASE, Cochrane Library (&Trail), Web of Science, CNKI, Wanfang and QVIP were applied to collect the randomized controlled trials (RCTs) from inception to Dec. 9th, 2019. Twenty-two studies were finally included containing 777 patients in the TAPB group and 783 cases in QLB group. RCTs comparing TAPB and QLB in postoperative analgesia were included in this meta-analysis. The indicators including total analgesia consumption postoperatively, operative time, duration of anesthesia, visual analogue scale (VAS) score at 24 h postoperatively, duration of postoperative analgesia, the number of patients requiring analgesia postoperatively and adverse reactions were analyzed. Results our findings showed that morphine consumption (mg) (WMD = 3.893, 95%CI: 2.053 to 5.733, P < 0.001), fentanyl consumption (μg) (WMD = 23.815, 95%CI: 15.521 to 32.109, P < 0.001), VAS score at 24 h postoperatively (WMD = 0.459, 95%CI: 0.118 to 0.801, P = 0.008), the number of patients requiring analgesia postoperatively (WMD = 3.893, 95%CI: 2.053 to 5.733, P < 0.001), and the incidence of dizziness (WMD = 2.691, 95%CI: 1.653 to 4.382, P < 0.001) in TAPB group were higher than in QLB group. Conclusions QLB is superior to TAPB in reducing morphine consumption, fentanyl consumption, VAS score at 24 h postoperatively, the number of patients requiring analgesia postoperatively, and the incidence of dizziness.
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Affiliation(s)
- Yanqing Wang
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No.55, Section 4, South Renmin Road, Chengdu, 610041, People's Republic of China
| | - Xiaojia Wang
- Department of Pain management, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Kexian Zhang
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No.55, Section 4, South Renmin Road, Chengdu, 610041, People's Republic of China.
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Li J, Tang S, Lam D, Hergrueter A, Dennis J, Liu H. Novel utilization of fascial layer blocks in hip and knee procedures. Best Pract Res Clin Anaesthesiol 2019; 33:539-551. [DOI: 10.1016/j.bpa.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/09/2019] [Indexed: 12/26/2022]
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Zhu M, Qi Y, He H, Lou J, Pei Q, Mei Y. Analgesic effect of the ultrasound-guided subcostal approach to transmuscular quadratus lumborum block in patients undergoing laparoscopic nephrectomy: a randomized controlled trial. BMC Anesthesiol 2019; 19:154. [PMID: 31412770 PMCID: PMC6694477 DOI: 10.1186/s12871-019-0825-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022] Open
Abstract
Background Quadratus lumborum block (QLB) is an effective analgesia that lowers opioid consumption after lower abdominal and hip surgeries. The subcostal approach to transmuscular QLB is a novel technique that can provide postoperative analgesia by blocking more dermatomes. The aim of this study is to evaluate the efficacy and viability of subcostal approach to QLB after laparoscopic nephrectomy. Methods Sixty patients who underwent laparoscopic nephrectomy were randomly divided into the subcostal approach to QLB group (QLB group, n = 30) and the control group (C group, n = 30). All patients underwent ultrasound-guided subcostal approach to QLB in an ipsilateral parasagittal oblique plane at the L1–L2 level. The QLB group received 0.4 cc/kg of 0.3% ropivacaine, and the C group received 0.4 cc/kg of 0.9% saline. Postoperatively, a patient-controlled intravenous analgesic pump with sufentanil was attached to all the patients. The primary outcome was sufentanil consumption within the first 24 h after surgery. The secondary outcomes included the Ramsey sedation scale (RSS) scores and Bruggemann comfort scale (BCS) scores 6 h (T1), 12 h (T2), and 24 h (T3) after surgery, intraoperative remifentanil consumption, number of patients requiring rescue analgesia, time to recovery of intestinal function, mobilization time after surgery, and presence of side effects. Results Sufentanil consumption within the first 24 h after surgery was significantly lower in the QLB group than in the C group (mean [standard deviation]: 34.1 [9.9] μg vs 42.1 [11.6] μg, P = .006). The RSS scores did not differ between the two groups, and the BCS scores of the QLB group at T1 and T2 time points was significantly higher than those of the C group(P<0.05). The consumption of remifentanil intraoperatively and the number of patients requiring rescue analgesia were significantly lower in the QLB group (P<0.05). Time to recovery of intestinal function and mobilization time after surgery were significantly earlier in the QLB group (P<0.05). The incidence of postoperative nausea and vomiting was significantly lower in the QLB group (P<0.05). Conclusions The ultrasound-guided subcostal approach to QLB is an effective analgesic technique in patients undergoing laparoscopic nephrectomy as it reduces the consumption of sufentanil postoperatively. Trial registration ChiCTR1800020296 0 (Prospective registered). Initial registration date was 22/12/2018.
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Affiliation(s)
- Manhua Zhu
- Department of Anesthesiology, Ningbo Medical Center Lihuili Eastern Hospital, Taipei Medical University Ningbo Medical Center, No.1111 jiangnan Road, Ningbo, Zhejiang, 315040, China
| | - Yong Qi
- Department of Anesthesiology, Ningbo Medical Center Lihuili Eastern Hospital, Taipei Medical University Ningbo Medical Center, No.1111 jiangnan Road, Ningbo, Zhejiang, 315040, China
| | - Huijuan He
- Department of Anesthesiology, Ningbo Medical Center Lihuili Eastern Hospital, Taipei Medical University Ningbo Medical Center, No.1111 jiangnan Road, Ningbo, Zhejiang, 315040, China
| | - Jinfeng Lou
- Department of Anesthesiology, Ningbo Medical Center Lihuili Eastern Hospital, Taipei Medical University Ningbo Medical Center, No.1111 jiangnan Road, Ningbo, Zhejiang, 315040, China
| | - Qingqing Pei
- Department of Anesthesiology, Ningbo Beilun People's Hospital, Ningbo, Zhejiang, China, No.1288 lushan east Road, Ningbo, 315800, China
| | - Yuliu Mei
- Department of Anesthesiology, Ningbo Beilun People's Hospital, Ningbo, Zhejiang, China, No.1288 lushan east Road, Ningbo, 315800, China.
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Tao T, Zhou Q. [Efficacy of erector spinae block versus retrolaminar block for postoperative analgesia following posterior lumbar surgery]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:736-739. [PMID: 31270055 DOI: 10.12122/j.issn.1673-4254.2019.06.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the effect of erector spinae plane block and retrolaminar block for relieving acute pain after posterior lumbar surgery. METHODS Eighty-nine patients undergoing selective posterior lumbar surgery under general anesthesia in our hospital between January and December, 2018, were recruited. Of these patients, 30 received total intravenous general anesthesia to serve as the control group, 28 received total intravenous general anesthesia (TIVA) combined with erector spinae plane block (ESPB), and 31 had TIVA combined with retrolaminar block (RLB). All the patients received patient-controlled intravenous analgesia (PCIA) for postoperative analgesia, and their heart rate, blood pressure, and pulse oximetry were routinely monitored during the anesthesia. VAS scores were evaluated before and at 2, 8, 12, 24, and 48 h after the surgery. Sufentanil consumption during the operation and PCIA were also recorded. The postoperative complications such as nausea and vomiting, urinary retention, itching and respiratory depression within 48 h after the surgery were also recorded. RESULTS At 2, 8 and 12 h postoperatively, VAS scores in the ESPB group and RLB group were significantly lower than those in the control group; the scores were significantly lower in RLB group than in ESPB group (P < 0.05). Compared with that in the control group, sufentanil consumption during the operation and PCIA were significantly decreased in both ESPB and RLB groups, particularly in the latter group (P < 0.05). Two patients experienced nausea and vomiting and 1 patient complained of pruritus in control group; 1 patient had over sedation and 1 had urinary retention in ESPB group; 1 patient had urinary retention in RLB group. CONCLUSIONS Ultrasound-guided RLB has better analgesic effect than ESPB for management of perioperative pain following posterior lumbar surgery.
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Affiliation(s)
- Tao Tao
- Department of Anesthesiology, Zhanjiang Central People's Hospital, Zhanjiang 524045, China
| | - Quan Zhou
- Department of Anesthesiology, Zhanjiang Central People's Hospital, Zhanjiang 524045, China
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