Ultrasound-guided Transmuscular Quadratus Lumborum Block for Elective Cesarean Section Significantly Reduces Postoperative Opioid Consumption and Prolongs Time to First Opioid Request

2020 ◽  
Vol 40 (2) ◽  
pp. 107-108
Author(s):  
C.K. Hansen ◽  
M. Dam ◽  
G.E. Steingrimsdottir ◽  
G.H. Laier ◽  
M. Lebech ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Opioid Consumption ◽  
Elective Cesarean Section ◽  
Ultrasound Guided ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Elective Cesarean

Ultrasound-guided transmuscular quadratus lumborum block for elective cesarean section significantly reduces postoperative opioid consumption and prolongs time to first opioid request: a double-blind randomized trial

2019 ◽  
Vol 44 (9) ◽  
pp. 896-900 ◽  
Author(s):  
Christian K Hansen ◽  
Mette Dam ◽  
Gudny E Steingrimsdottir ◽  
Gunnar Hellmund Laier ◽  
Morten Lebech ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Cesarean Section ◽  
Opioid Consumption ◽  
Elective Cesarean Section ◽  
Ultrasound Guided ◽  
Double Blind ◽  
Pain Scores ◽  
Quadratus Lumborum ◽  
Opioid Administration ◽  
Elective Cesarean

BackgroundElective cesarean section (ECS) can cause moderate to severe pain that often requires opioid administration. To enhance maternal recovery, and promote mother and baby interaction, it is important to reduce postoperative pain and opioid consumption. Various regional anesthesia techniques have been implemented to improve postoperative pain management following ECS. This study aimed to investigate the efficacy of bilateral ultrasound-guided transmuscular quadratus lumborum (TQL) block on reducing postoperative opioid consumption following ECS.MethodsA randomized double-blind trial with concealed allocation was conducted in 72 parturients who received bilateral TQL block with either 30 mL ropivacaine 0.375% or saline. TQL block injectate was deposited in the interfascial plane between the quadratus lumborum and psoas major muscles, posterior to the transversalis fascia. Primary outcome was opioid consumption, which was recorded electronically. Pain scores and time to first opioid request were also evaluated.ResultsOpioid consumption (oral morphine equivalents, OME) was significantly reduced in group ropivacaine (GRO) in the first 24 hours compared with group saline (65 mg OME vs 94 mg OME) with a mean difference of 29 mg OME; 95% CI 3 to 55, p<0.03. Time to first opioid request was significantly prolonged in GRO, p<0.003. Numerical rating scale pain scores were significantly lower in GRO in the first 6 hours after surgery, p<0.03.ConclusionsBilateral TQL block significantly reduced 24 hours’ opioid consumption. Further, we observed significant prolongation in time to first opioid, and significant reduction of pain during the first 6 postoperative hours.

scholarly journals Postoperative analgesia and opioid use following hip arthroscopy with ultrasound-guided quadratus lumborum block: a randomized controlled double-blind trial

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092099
Author(s):  
Liangjing Yuan ◽  
Ye Zhang ◽  
Chengshi Xu ◽  
Anshi Wu
Keyword(s):  
General Anesthesia ◽  
Hip Arthroscopy ◽  
Opioid Consumption ◽  
Hip Surgery ◽  
Opioid Use ◽  
Ultrasound Guided ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Vas Scores ◽  
Time Point

Objective To investigate the postoperative analgesic effect of ultrasound-guided quadratus lumborum block (QLB) in patients undergoing arthroscopic hip surgery. Methods Patients who were scheduled to undergo elective arthroscopic hip surgery were randomly assigned to the QLB (Q) or control (C) group (n = 40 each). After general anesthesia induction, unilateral QLB was performed under ultrasound guidance in the Q group. The amount of opioid use via patient-controlled analgesia (PCA) and the resting and movement pain visual analog scale (VAS) scores when the patient left the postanesthesia care unit (PACU) and 4, 8, 12, and 24 hours after surgery were recorded. Postoperative complications were recorded for both groups. Results At 24 hours post-surgery, opioid consumption amounts via PCA (48.4 [48.1–48.6] mL) in the Q group were significantly lower compared with the C group (52.0 [51.0–53.8] mL). A significant reduction in opioid consumption was observed between the two groups at each time point. Resting and movement VAS scores at each time point were significantly lower in the Q compared with the C group. Conclusions Hip arthroscopy patients who received QLB and general anesthesia in combination had less pain and a lower opioid requirement within 24 hours postoperatively.

scholarly journals Ultrasound-Guided Anterior Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Related Side Effects in Patients Undergoing Total Hip Replacement Arthroplasty: A Propensity Score-Matched Cohort Study

2021 ◽  
Vol 10 (20) ◽  
pp. 4632
Author(s):  
Yeon-Ju Kim ◽  
Hyung-Tae Kim ◽  
Ha-Jung Kim ◽  
Pil-Whan Yoon ◽  
Ji-In Park ◽  
...  
Keyword(s):  
Side Effects ◽  
Propensity Score ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Opioid Consumption ◽  
Ultrasound Guided ◽  
Pain Scores ◽  
Quadratus Lumborum Block ◽  
Replacement Arthroplasty ◽  
Quadratus Lumborum

Quadratus lumborum block (QLB) has been shown to be effective for pain relief after hip surgery. This study evaluated the efficacy of ultrasound-guided anterior QLB in pain control after total replacement hip arthroplasty (TRHA). A total of 115 patients receiving anterior QLB were propensity score-matched with 115 patients who did not receive the block. The primary outcome was opioid consumption at 24, 24–48, and 48 postoperative hours. Secondary outcomes included pain scores at the post-anesthesia care unit (PACU), 8, 16, 24, 32, 40, and 48 h length of hospital stay, time to first ambulation, and the incidence of opioid-related side effects. Postoperative opioid consumption 48 h after surgery was significantly lower in the QLB group. Resting, mean, worst, and the difference of resting pain scores compared with preoperative values were significantly lower in the QLB group during the 48 postoperative hours. The length of hospital stay was shorter in the QLB group. The incidence of postoperative nausea and vomiting was significantly lower in the QLB group during the 48 postoperative hours, except at the PACU. This study suggests that anterior QLB provides effective postoperative analgesia for patients undergoing THRA performed using the posterolateral approach.

scholarly journals Analgesic effectiveness of quadratus lumborum block for patients after abdominal surgery: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Tianyu Liu ◽  
Chao Xu ◽  
He Zhu ◽  
Xiuxiu Gao ◽  
Lulu Guo ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Cesarean Section ◽  
Abdominal Surgery ◽  
Meta Analysis ◽  
Opioid Consumption ◽  
Cochrane Library ◽  
Control Group ◽  
Vas Score ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum

Abstract Background: A series of studies have reported that quadratus lumborum block (QLB) can have a great postoperative analgesia for lower abdominal surgery. However, a meta-analysis of the analgesic effect of QLB in patients undergoing lower abdominal surgery has not been published.Methods： We searched the databases of Pubmed, Embase, Cochrane Library, and Web of Science (updated to October 15, 2019). We cumulative opioid consumption at 6, 12, 24 and 48h after surgery; pain score (rest and dynamic) at 6, 12, 24 and 48h after surgery; occurrence of common opioid-related complications at 24h after surgery . Opioid consumption as the main outcome.Results：Thirteen randomized controlled trials (RCTs) including 751 patients were analysed. Compared with control group, QLB group can effectively reduce 24 and 48h cumulative opioid consumption 10.1mg (95%CI: -13,-7.2; p<0.00001) and 16.22mg (95%CI: -19.39,13.03; p<0.00001) in patients with cesarean section, but can reduce effectively cumulative opioid consumption in patients undergoing laparoscopic surgery at 6, 12 and 24h. Posterior QLB group and transmuscular QLB group reduced 24h cumulative opioid consumption 4.03mg ( 95%CI: -7.89, -0.19; p=0.04) and 12.44mg ( 95%CI: -20.2, -4.68; p=0.002), respectively. QLB group reduced rest visual analogue scale (VAS) score at 12 , 24 and 48 h ,however, the effective reduction of rest VAS score in patients undergoing cesarean section only occurs at 24h after surgery.Conclusion：QLB seems to provide better analgesia for patients undergoing laparoscopic surgery than patients undergoing cesarean section. Transmuscular QLB appears to have reduced postoperative opioid consumption compared to posterior QLB. More future RCTs are needed to support our conclusions.

Acute Dystonia after a Single Dose of Intravenous Metoclopramide during Elective Cesarean Section: A Case Report.

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Danielle Levin
Keyword(s):  
Single Dose ◽  
Case Report ◽  
Cesarean Section ◽  
Epidural Anesthesia ◽  
Elective Cesarean Section ◽  
Single Administration ◽  
Dystonic Reaction ◽  
Elective Cesarean ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

We would like to present the first report of severe acute dystonic reaction after a single administration of metoclopramide during cesarean section under combined spinal-epidural anesthesia.  During elective cesarean section, a 30-year-old female vomited four times and was treated with 10mg intravenous metoclopramide and 8mg intravenous ondansetron.  Nausea subsided with the antiemetic treatment, but two minutes later, patient had rapid eye blinking, uncontrollable head movement, and became unresponsive.  Bolus of 50mg intravenous diphenhydramine resolved the acute dystonic symptoms within seconds.  Patient was again oriented times three, with no recollection of symptoms, and remained symptom free for the rest of admission. 

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