Ultrasound guided quadratus lumborum block for postoperative analgesia in pediatric ambulatory inguinal hernia repair

Abstract Background: early postoperative ambulation and reduction of hospital stay necessitate efficient postoperative analgesia. Quadrates Lumborum Block (QLB) has been described to provide adequate postoperative analgesia after abdominal surgery. This randomized comparative trial was designed to compare the duration of analgesia provided by two different QLB approaches; the posterior QLB (QLB-2) and transmuscular QLB (QLB-3) in patients undergoing surgical repair of unilateral inguinal hernia. Methods: Forty patients, aged from 18-50 years, ASA physical status I or II, scheduled for unilateral inguinal hernia repair were enrolled. At the end of the surgical procedure and before recovery from general anesthesia, Patients were randomly assigned into two groups to receive either posterior QLB (Group QLB-2) or transmuscular QLB (Group QLB-3) using 20 ml 0.25% bupivacaine. Duration of analgesia, postoperative VAS and postoperative opioid consumption were recorded. Results: duration of block was significantly longer in QLB-3 group when compared to QLB-2 group (20.1 + 6.2 hours versus 12.0 + 4.8 respectively) with P value of < 0.001. A statistically significant lower VAS score was recorded in QLB-3 group immediately and 12 hrs postoperative. QLB-3 group showed a statistically significant delayed time of first analgesic request and less postoperative morphine consumption with P value of < 0.001 and 0.001 respectively. Conclusions: Ultrasound guided postsurgical transmuscular approach of QLB (QLB-3) using 20 ml 0.25% bupivacaine produces more postoperative analgesic effect and less postoperative opioid consumption when compared to posterior QLB approach (QLB-2) in patients underwent unilateral inguinal hernia repair under general anesthesia. Trial Registration: ClinicalTrials.gov identifier: NCT03526731- on 16 May 2018 Keywords: Quadratus lumborum block - Ultrasound-guided transmuscular quadratus lumborum blockade - ultrasound-guided lumbar plexus technique – ultrasound guided transversus abdominus plan block.

Download Full-text

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

10.21203/rs.2.289/v1 ◽

2019 ◽

Author(s):

Maher Fawzy ◽

Mohamed AR. Nasr ◽

Abeer Ahmed ◽

Mohsen M. Waheb ◽

Ayman M. Hussam ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

General Anesthesia ◽

Inguinal Hernia Repair ◽

Postoperative Analgesia ◽

Opioid Consumption ◽

P Value ◽

Ultrasound Guided ◽

Unilateral Inguinal Hernia ◽

Quadratus Lumborum

Abstract Background: early postoperative ambulation and reduction of hospital stay necessitate efficient postoperative analgesia. Quadrates Lumborum Block (QLB) has been described to provide adequate postoperative analgesia after abdominal surgery. This randomized comparative trial was designed to compare the duration of analgesia provided by two different QLB approaches; the posterior QLB (QLB-2) and transmuscular QLB (QLB-3) in patients undergoing surgical repair of unilateral inguinal hernia. Methods: Forty patients, aged from 18-50 years, ASA physical status I or II, scheduled for unilateral inguinal hernia repair were enrolled. At the end of the surgical procedure and before recovery from general anesthesia, Patients were randomly assigned into two groups to receive either posterior QLB (Group QLB-2) or transmuscular QLB (Group QLB-3) using 20 ml 0.25% bupivacaine. Duration of analgesia, postoperative VAS and postoperative opioid consumption were recorded. Results: duration of block was significantly longer in QLB-3 group when compared to QLB-2 group (20.1 + 6.2 hours versus 12.0 + 4.8 respectively) with P value of < 0.001. A statistically significant lower VAS score was recorded in QLB-3 group immediately and 12 hrs postoperative. QLB-3 group showed a statistically significant delayed time of first analgesic request and less postoperative morphine consumption with P value of < 0.001 and 0.001 respectively. Conclusions: Ultrasound guided postsurgical transmuscular approach of QLB (QLB-3) using 20 ml 0.25% bupivacaine produces more postoperative analgesic effect and less postoperative opioid consumption when compared to posterior QLB approach (QLB-2) in patients underwent unilateral inguinal hernia repair under general anesthesia. Trial Registration: ClinicalTrials.gov identifier: NCT03526731- on 16 May 2018. Keywords: Quadratus lumborum block - Ultrasound-guided transmuscular quadratus lumborum blockade - ultrasound-guided lumbar plexus technique – ultrasound guided transversus abdominus plan block.

Download Full-text

06 / Quadratus lumborum block for laparoscopic inguinal hernia repair: case series.

10.26226/morressier.5aeb0ac607b0d6001a79a22d ◽

2018 ◽

Author(s):

Rodrigo Tadashi Martines ◽

Murillo Favaro ◽

Anderson Alcoforado de Araújo

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Case Series ◽

Laparoscopic Inguinal Hernia Repair ◽

Laparoscopic Inguinal Hernia ◽

Quadratus Lumborum Block ◽

Quadratus Lumborum

Download Full-text

Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2019-101027 ◽

2020 ◽

Vol 45 (3) ◽

pp. 187-191 ◽

Cited By ~ 4

Author(s):

Gözen Öksüz ◽

Mahmut Arslan ◽

Aykut Urfalıoğlu ◽

Ahmet Gökhan Güler ◽

Şeyma Tekşen ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Postoperative Analgesia ◽

Pediatric Patients ◽

Demographic Data ◽

Parent Satisfaction ◽

Caudal Block ◽

Double Blind ◽

Quadratus Lumborum

Background and objectivesCaudal epidural anesthesia is a widely used popular technique for postoperative analgesia but it has potential side effects and duration of analgesia is short. Quadratus lumborum block (QLB) was found to be an effective method for postoperative analgesia in lower abdominal surgeries. In this double-blind prospective randomized trial, we aimed to compare the postoperative analgesic efficacies of QLB and the caudal block in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries under general anesthesia.Materials and methodsAfter approval was obtained from the ethics committee, in this prospective randomized double-blind trial, 53 patients under general anesthesia undergoing inguinal hernia repair and orchiopexy surgeries randomly received caudal block or QLB. Demographic data, postoperative analgesic requirement, Face, Legs, Activity, Cry, and Consolability (FLACC) scores at 30 min, 1, 2, 4, 6, 12 and 24 hours, parent satisfaction scores and complications were recorded.ResultsThe study included 52 patients, after excluding one patient because of a failed caudal block. There were no significant differences between the groups based on demographic data (p>0.05). The number of patients who required analgesics in the first 24 hours was significantly lower in QLB group (p=0.001). Postoperative 4, 6, 12 hours FLACC scores were significantly lower in the QLB group (p<0.001, p=0.001 and p<0.001, respectively). Parent satisfaction scores were higher in the QLB group (p=0.014).ConclusionAccording to the results of this study, QLB can provide much more effective analgesia than caudal block without adjuvants in multimodal analgesia management of children undergoing inguinal hernia repair and orchiopexy surgeries.Trial registration numberNCT03294291.

Download Full-text