Subcostal approach to anterior quadratus lumborum block for pain control following open urological procedures

2019 ◽  
Vol 33 (1) ◽  
pp. 148-154 ◽  
Author(s):  
Hesham Elsharkawy ◽  
Sanchit Ahuja ◽  
Sean DeGrande ◽  
Kamal Maheshwari ◽  
Vincent Chan
Keyword(s):  
Pain Control ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Urological Procedures

scholarly journals Bilateral posterior Quadratus Lumborum block for pain relief after cesarean delivery: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pawinee Pangthipampai ◽  
Sukanya Dejarkom ◽  
Suppachai Poolsuppasit ◽  
Choopong Luansritisakul ◽  
Suwida Tangchittam
Keyword(s):  
Side Effects ◽  
Cesarean Delivery ◽  
Pain Control ◽  
Spinal Block ◽  
Side Group ◽  
Link Type ◽  
Quadratus Lumborum Block ◽  
Analgesic Regimen ◽  
Quadratus Lumborum ◽  
Median Pain

Abstract Background Achieving optimal analgesia with few side effects is the goal of pain management after cesarean delivery. Intrathecal (IT) morphine is the current standard but ultrasound-guided quadratus lumborum block (QLB) may offer superior pain control with fewer side effects. This study compared the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine, with IT morphine and bilateral QLB, or only bilateral QLB. Methods Parturients having elective cesarean delivery under spinal block were randomized and allocated into IT morphine 0.2 mg with sham QLB (Group IT), IT morphine 0.2 mg and bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group IT+QLB), or bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group QLB). A PCA pump was connected after completion of the QLB or sham block. The first time to PCA morphine requirement was recorded and compared. Results Eighty parturients were included. Analysis of Group QLB was terminated early because at the second interim analysis, median pain-free period was significantly shorter in Group QLB [hours (95%CI): 2.50 (1.04–3.96) in Group IT vs. 7.75 (5.67–9.83) in IT+QLB vs. 1.75 (0.75–2.75) in QLB (p < 0.001)]. The median (min, max) amount of morphine required during 24 h was 5.5 (0–25) in Group IT vs. 5.0 (0–36) in IT+QLB vs. 17.5 (1–40) mg in Group QLB (p < 0.001). In the final analysis the median pain-free period was 2.50 (1.23–3.77) hours (95%CI) in Group IT (n = 27) vs. 8.02 (5.96–10.07) in IT+QLB (n = 28). (p = 0.027). Conclusion US-QLB used in conjunction with IT morphine yielded a statistically significant longer median pain-free period compared with standard IT morphine alone. However, QLB alone provided inferior pain control compared with standard IT morphine. When combined with IT morphine, QLB could provide additional analgesic benefit as a part of multimodal analgesic regimen, especially during the early postoperative period. Trial registration ClinicalTrials.gov no. NCT03199170 Date registered on June 22, 2017. Prospectively registered.

scholarly journals Bilateral Posterior Quadratus Lumborum Block for Pain Relief after Cesarean Delivery: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Pawinee Pangthipampai ◽  
Sukanya Dejarkom ◽  
Suppachai Poolsuppasit ◽  
Choopong Luansritisakul Luansritisakul ◽  
Suwida Tangchittam
Keyword(s):  
Side Effects ◽  
Cesarean Delivery ◽  
Pain Control ◽  
Intrathecal Morphine ◽  
Spinal Block ◽  
Side Group ◽  
Quadratus Lumborum Block ◽  
Analgesic Regimen ◽  
Quadratus Lumborum ◽  
Median Pain

Abstract Background: Achieving optimal abdominal analgesia with few side effects is the goal of pain management after cesarean delivery. Intrathecal morphine is the current standard but ultrasound guided quadratus lumborum block (US-QLB) may offer superior pain control with fewer side effects. This study compared the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine 0.2 mg, with IT morphine 0.2 mg and bilateral QLB, or only bilateral QLB.Methods: Parturients having elective cesarean delivery with a low transverse incision under spinal block were randomized to three groups. Subjects were allocated into IT morphine 0.2 mg with sham QLB (Group IT morphine), IT morphine 0.2 mg and bilateral QLB with 0.25% bupivacaine 25 ml and adrenaline 1:250,000 in each side (Group IT morphine with QLB), or bilateral QLB with 0.25% bupivacaine 25 ml and adrenaline 1:250,000 in each side (Group QLB). A PCA pump was connected to each parturient after completion of the QLB or sham block. The first time to PCA morphine requirement when parturients experienced pain was recorded and compared.Results: Eighty parturients were included. Analysis of Group QLB was terminated early because Kaplan-Meier survival analysis showed the median pain-free period to be significantly shorter in Group QLB at the second interim analysis; [2.50 hours (95% CI: 1.04-3.96) in Group IT morphine vs. 7.75 (95% CI: 5.67-9.83) in Group IT morphine with QLB vs. 1.75 (95% CI: 0.75-2.75) in Group QLB (overall p<0.001)]. The median (min, max) amount of morphine required during 24 hours was 5.5 (0-25) in Group IT morphine vs. 5.0 (0-36) in Group IT morphine with QLB vs. 17.5 (1-40) mg in Group QLB (p<0.001). In the final analysis the median pain-free period was 2.50 hours (95%CI: 1.23-3.77) in Group IT morphine (n=27) and 8.02 (95%CI: 5.96-10.07) in Group IT morphine with QLB (n=28). (Gehan-Breslow p=0.027).Conclusion: US-QLB used in conjunction with IT morphine yielded a statistically significant longer median pain-free period compared with standard IT morphine alone. However, QLB alone provided inferior pain control compared with standard IT morphine. When combined with IT morphine, QLB may provide additional analgesic benefit as a part of multimodal analgesic regimen, especially during the early postoperative period.Trial registration: ClinicalTrials.gov no. NCT03199170 Date registered on June 22, 2017. Prospectively registered.

scholarly journals Comparison Of Transversus Abdominis Plan Block And Quadratus Lumborum Block For Postoerative Pain Control Following Laparoscopic Cholecystectomy

2020 ◽  
Author(s):  
Merve Kacan ◽  
Handan Gulec ◽  
berrin kosar ◽  
seda ilhan ◽  
Eyup Horasanli
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Control ◽  
Transversus Abdominis ◽  
Morphine Consumption ◽  
Consumption Values ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Significant Difference ◽  
Elective Laparoscopic Cholecystectomy ◽  
Effective Analgesia

Abstract BACKGROUND To compare Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane (TAP) blocks for postoperative pain control following laparoscopic cholecystectomy. Study and Design Prospective randomized head-to-head clinical trial. Methods A total of 60 patients who were set to undergo elective laparoscopic cholecystectomy were randomly separated into two groups. QLB was preoperatively applied to 30 patients and TAP block was also applied to 30 patients. A record was made of the intraoperative additional fentanyl dose, and at postoperative 0-1-2-4-6-12-24 hours, records were made of cumulative morphine consumption, number of morphine requests, VAS values, shoulder pain, heartrate, systolic and diastolic blood pressure, SpO2, sedation score (Ramsey scale), itching, nausea and vomiting, respiratory depression, and other complications. Results In the examination of intraoperative additional fentanyl use, there was no requirement for additional fentanyl in 86.7% of the QLB group, while in 60% of the TAP group, there was seen to be at least one dose of additional fentanyl required. At all timepoints between 0 and 24 hours postoperatively, the cumulative morphine requests and morphine consumption values were significantly lower in the QLB group than in the TAP group. No statistically significant difference was determined between the groups with respect to nausea, vomiting, sedation, and itching as morphine-related side effects. Conclusion Morphine consumption was significantly lower in patients who underwent QLB procedure at 6, 12, 24, and 48 hours compared to the TAP group. In general, effective analgesia was provided by both methods, but more effective analgesia was determined to have been provided in the QLB group compared to the TAP group, and thus QLB can be preferable to TAP.

Anterior Quadratus Lumborum Block Does Not Provide Superior Pain Control after Hip Arthroscopy: A Double-Blinded Randomized Controlled Trial

2021 ◽  
Author(s):  
Stephen C. Haskins ◽  
Audrey Tseng ◽  
Haoyan Zhong ◽  
Marko Mamic ◽  
Stephanie I. Cheng ◽  
...  
Keyword(s):  
Treatment Effect ◽  
Standard Error ◽  
Hip Arthroscopy ◽  
Pain Control ◽  
Multimodal Analgesia ◽  
Motor Deficit ◽  
Pain Scores ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Double Blinded

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 What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Continuous quadratus lumborum block as post-operative strategy for pain control in spinal fusion surgery

2020 ◽  
Vol 64 (10) ◽  
pp. 869
Author(s):  
Jon Wilton ◽  
Helen Chiu ◽  
Natalie Codianne ◽  
Herschel Knapp ◽  
VicenteRoques Escolar ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Pain Control ◽  
Operative Strategy ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum

scholarly journals Bilateral Posterior Quadratus Lumborum Block for Pain Relief after Cesarean Delivery: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Pawinee Pangthipampai ◽  
Sukanya Dejarkom ◽  
Suppachai Poolsuppasit ◽  
Choopong Luansritisakul Luansritisakul ◽  
Suwida Tangchittam
Keyword(s):  
Side Effects ◽  
Cesarean Delivery ◽  
Pain Control ◽  
Controlled Trial ◽  
Spinal Block ◽  
Side Group ◽  
Quadratus Lumborum Block ◽  
Analgesic Regimen ◽  
Quadratus Lumborum ◽  
Median Pain

Abstract Background: Achieving optimal analgesia with few side effects is the goal of pain management after cesarean delivery. Intrathecal (IT) morphine is the current standard but ultrasound-guided quadratus lumborum block (QLB) may offer superior pain control with fewer side effects. This study compared the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine, with IT morphine and bilateral QLB, or only bilateral QLB.Methods: Parturients having elective cesarean delivery under spinal block were randomized and allocated into IT morphine 0.2 mg with sham QLB (Group IT), IT morphine 0.2 mg and bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group IT+QLB), or bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group QLB). A PCA pump was connected after completion of the QLB or sham block. The first time to PCA morphine requirement was recorded and compared.Results: Eighty parturients were included. Analysis of Group QLB was terminated early because at the second interim analysis, median pain-free period is significantly shorter in Group QLB [hours (95%CI): 2.50 (1.04-3.96) in Group IT vs. 7.75 (5.67-9.83) in IT+QLB vs. 1.75 (0.75-2.75) in QLB (p<0.001)]. The median (min, max) amount of morphine required during 24 hours was 5.5 (0-25) in Group IT vs. 5.0 (0-36) in IT+QLB vs. 17.5 (1-40) mg in Group QLB (p<0.001). In the final analysis the median pain-free period was 2.50 (1.23-3.77) hours (95%CI) in Group IT (n=27) vs. 8.02 (5.96-10.07) in IT+QLB (n=28). (p=0.027).Conclusion: US-QLB used in conjunction with IT morphine yielded a statistically significant longer median pain-free period compared with standard IT morphine alone. However, QLB alone provided inferior pain control compared with standard IT morphine. When combined with IT morphine, QLB can provide additional analgesic benefit as a part of multimodal analgesic regimen, especially during the early postoperative period.

scholarly journals Bilateral Posterior Quadratus Lumborum Block for Pain Relief after Cesarean Delivery: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Pawinee Pangthipampai ◽  
Sukanya Dejarkom ◽  
Suppachai Poolsuppasit ◽  
Choopong Luansritisakul Luansritisakul ◽  
Suwida Tangchittam
Keyword(s):  
Side Effects ◽  
Cesarean Delivery ◽  
Pain Control ◽  
Controlled Trial ◽  
Spinal Block ◽  
Side Group ◽  
Quadratus Lumborum Block ◽  
Analgesic Regimen ◽  
Quadratus Lumborum ◽  
Median Pain

Abstract Background: Achieving optimal analgesia with few side effects is the goal of pain management after cesarean delivery. Intrathecal (IT) morphine is the current standard but ultrasound-guided quadratus lumborum block (QLB) may offer superior pain control with fewer side effects. This study compared the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine, with IT morphine and bilateral QLB, or only bilateral QLB. Methods: Parturients having elective cesarean delivery under spinal block were randomized and allocated into IT morphine 0.2 mg with sham QLB (Group IT), IT morphine 0.2 mg and bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group IT+QLB), or bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group QLB). A PCA pump was connected after completion of the QLB or sham block. The first time to PCA morphine requirement was recorded and compared. Results: Eighty parturients were included. Analysis of Group QLB was terminated early because at the second interim analysis, median pain-free period is significantly shorter in Group QLB [hours (95%CI): 2.50 (1.04-3.96) in Group IT vs. 7.75 (5.67-9.83) in IT+QLB vs. 1.75 (0.75-2.75) in QLB (p<0.001)]. The median (min, max) amount of morphine required during 24 hours was 5.5 (0-25) in Group IT vs. 5.0 (0-36) in IT+QLB vs. 17.5 (1-40) mg in Group QLB (p<0.001). In the final analysis the median pain-free period was 2.50 (1.23-3.77) hours (95%CI) in Group IT (n=27) vs. 8.02 (5.96-10.07) in IT+QLB (n=28). (p=0.027). Conclusion: US-QLB used in conjunction with IT morphine yielded a statistically significant longer median pain-free period compared with standard IT morphine alone. However, QLB alone provided inferior pain control compared with standard IT morphine. When combined with IT morphine, QLB can provide additional analgesic benefit as a part of multimodal analgesic regimen, especially during the early postoperative period.

scholarly journals Comparison of transversus abdominis plan block and quadratus lumborum block for postoerative pain control following laparoscopic cholecystectomy

2020 ◽  
Author(s):  
Merve Kacan ◽  
Handan Gulec ◽  
berrin kosar ◽  
seda ilhan ◽  
Eyup Horasanli
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Control ◽  
Transversus Abdominis ◽  
Morphine Consumption ◽  
Consumption Values ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Significant Difference ◽  
Elective Laparoscopic Cholecystectomy ◽  
Effective Analgesia

Abstract BackgroundTo compare Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane (TAP) blocks for postoperative pain control following laparoscopic cholecystectomy.Study and Design Prospective randomized head-to-head clinical trial. Methods A total of 60 patients who were set to undergo elective laparoscopic cholecystectomy were randomly separated into two groups. QLB was preoperatively applied to 30 patients and TAP block was also applied to 30 patients. A record was made of the intraoperative additional fentanyl dose, and at postoperative 0-1-2-4-6-12-24 hours, records were made of cumulative morphine consumption, number of morphine requests, VAS values, shoulder pain, heartrate, systolic and diastolic blood pressure, SpO2, sedation score (Ramsey scale), itching, nausea and vomiting, respiratory depression, and other complications.Results In the examination of intraoperative additional fentanyl use, there was no requirement for additional fentanyl in 86.7% of the QLB group, while in 60% of the TAP group, there was seen to be at least one dose of additional fentanyl required. At all timepoints between 0 and 24 hours postoperatively, the cumulative morphine requests and morphine consumption values were significantly lower in the QLB group than in the TAP group. No statistically significant difference was determined between the groups with respect to nausea, vomiting, sedation, and itching as morphine-related side effects.Conclusion Morphine consumption was significantly lower in patients who underwent QLB procedure at 6, 12, 24, and 48 hours compared to the TAP group. In general, effective analgesia was provided by both methods, but more effective analgesia was determined to have been provided in the QLB group compared to the TAP group, and thus QLB can be preferable to TAP.

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