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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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Tsao SH, Wang CH, Juang HH, Lin YH, Yang PS, Chang PL, Chen CL, Hou CP. Surgery for Xanthogranulomatous Pyelonephritis: A Comparison of Midline Transperitoneal and Flank Retroperitoneal Laparotomy Approaches to Nephrectomy. J Clin Med 2022; 11:jcm11154476. [PMID: 35956092 PMCID: PMC9369389 DOI: 10.3390/jcm11154476] [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: 06/07/2022] [Revised: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 02/01/2023] Open
Abstract
Xanthogranulomatous pyelonephritis (XGP) is a rare inflammatory disease often associated with high morbidity and mortality. Whether the midline transperitoneal or the flank retroperitoneal approach is superior remains unknown. We searched through pathology databases and reviewed 86 patients with an XGP diagnosis from 2000 to 2021 at our institution. After the patients who did not meet the inclusion criteria were excluded, 35 patients who had undergone nephrectomy through the midline transperitoneal or the flank retroperitoneal laparotomy approach were recruited. Nine (25.71%) of the thirty-five patients underwent nephrectomy through a midline approach, whereas twenty-six (74.29%) received a flank approach. Patients in the midline approach group had a longer surgical time (p = 0.03) than those in the flank approach group. In addition, patients in the flank approach group took less time after surgery to resume oral intake than those in the midline approach group (p = 0.01). No significant differences in the rates of intraoperative and postoperative complications such as peritonitis or intraabdominal infection were observed between the groups. For the patients with XGP who are good candidates for surgery, nephrectomy is a relatively safe surgical treatment method. Both surgical methods produced favorable surgical outcomes, and the patients who received these methods had similar complication rates.
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Affiliation(s)
- Shu-Han Tsao
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-H.T.); (H.-H.J.); (Y.-H.L.); (P.-S.Y.); (P.-L.C.); (C.-L.C.)
| | - Chien-Ho Wang
- Deartment of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan;
| | - Horng-Heng Juang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-H.T.); (H.-H.J.); (Y.-H.L.); (P.-S.Y.); (P.-L.C.); (C.-L.C.)
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Anatomy, School of Medicine, Chang Gung University, Kwei-Shan, Taoyuan 333, Taiwan
| | - Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-H.T.); (H.-H.J.); (Y.-H.L.); (P.-S.Y.); (P.-L.C.); (C.-L.C.)
| | - Pei-Shan Yang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-H.T.); (H.-H.J.); (Y.-H.L.); (P.-S.Y.); (P.-L.C.); (C.-L.C.)
| | - Phei-Lang Chang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-H.T.); (H.-H.J.); (Y.-H.L.); (P.-S.Y.); (P.-L.C.); (C.-L.C.)
| | - Chien-Lun Chen
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-H.T.); (H.-H.J.); (Y.-H.L.); (P.-S.Y.); (P.-L.C.); (C.-L.C.)
| | - Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-H.T.); (H.-H.J.); (Y.-H.L.); (P.-S.Y.); (P.-L.C.); (C.-L.C.)
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu 300, Taiwan
- Correspondence:
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