scholarly journals Comparison of ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament with posterior quadratus lumborum block for perioperative analgesia in laparoscopic nephrectomy: a protocol for a randomised, prospective, parallel group, non-inferior trial

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e048490
Author(s):  
Xiao Huang ◽  
Yuan Sun ◽  
Rong Shi ◽  
Danxu Ma ◽  
Anshi Wu ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Analgesic Effect ◽  
Laparoscopic Nephrectomy ◽  
Patient Satisfaction Score ◽  
Perioperative Analgesia ◽  
Quadratus Lumborum Block ◽  
Parallel Group ◽  
Quadratus Lumborum ◽  
First Onset ◽  
Arcuate Ligament

ObjectiveAnterior quadratus lumborum block at the lateral supra-arcuate ligament (QLBA) is a new method for postoperative pain relief in patients undergoing abdominal surgery. Perioperative QLBA is effective, but it has not been compared with posterior quadratus lumborum block (QLB2). The present study aims to evaluate the postoperative pain of patients undergoing laparoscopic nephrectomy surgery with QLBA versus QLB2.Methods/designThis study is a randomised, prospective, parallel group, non-inferior trial. All patients undergoing laparoscopic nephrectomy surgery will be randomised 1:1 to the QLBA group or the QLB2 group with general anaesthesia. The objective of the trial is to evaluate the postoperative pain of patients undergoing laparoscopic nephrectomy surgery with QLBA (n=50) versus QLB2 (n=50). The primary outcome for this trial is the Visual Analogue Scale scores at rest and activity (dynamic pain scores are assessed with a cough or a trial to sit up in bed) 2 hours after surgery between patients who receive QLBA versus QLB2. The secondary objectives will be to compare (1) pain at rest and activity 0.5 hour, 2 hours, 24 hours, 48 hours after surgery; (2) the time spent on block operation; (3) the blocked dermatomal coverage 5 min and 15 min after block operation; (4) intraoperative opioid consumption; (5) types and doses of the rescue analgesic after surgery; (6) nausea and vomiting score within 24 hours after surgery; (7) time from the end of surgery to the first onset significant pain; (8) patient satisfaction score.DiscussionClinical experience has supported that QLB is a very effective postoperative analgesic method, and we will answer the following questions in this trial: Will both approaches have the same analgesic effect and duration? Will the QLBA have a non-inferior postoperative analgesic effect compared with QLB2 or the QLBA be able to prolong the duration of analgesia after surgery? The results of this study could have actual clinical applications that could help to reduce postoperative pain and shorten hospital stays.Ethics and disseminationThe study design was approved by the ethical committee of Beijing Chao-Yang Hospital, Beijing, China (2020-ke-321). The trial results will be published in peer-reviewed journals and at conferences.Trial registration numberChiCTR2000035354.

scholarly journals A Randomised Controlled Trial on Analgesic Effect of Repeated Quadratus Lumborum Block Versus Continuous Epidural Analgesia Following Laparoscopic Nephrectomy

2019 ◽  
Author(s):  
Dita Aditianingsih ◽  
Pryambodho Pryambodho ◽  
Naufal Anasy ◽  
Aida Rosita Tantri ◽  
Chaidir Arif Mochtar
Keyword(s):  
Postoperative Pain ◽  
Epidural Analgesia ◽  
Laparoscopic Nephrectomy ◽  
Epidural Group ◽  
Pain Scores ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Continuous Epidural Analgesia ◽  
Randomised Controlled ◽  
Urinary Catheterisation

Abstract Background Epidural analgesia as the pain management for abdominal surgery has side effects such as paraesthesia, hypotension, haematomas, and impaired motoric of lower limbs. The quadratus lumborum block (QLB) has potential as an abdominal truncal block, however, the analgesic efficacy of QLB compared to epidural analgesia is unknown. This prospective randomised controlled study compared the effectiveness of QLB on postoperative opioid requirement and pain intensity with the epidural analgesia technique in transperitoneal laparoscopic nephrectomy. Methods Sixty-two patients underwent laparoscopic donor nephrectomy were randomised to receive QLB (n=31) or continuous epidural (n=31). The QLB group received bilateral QLB with 0.3–0.4 ml/kg bupivacaine 0.25% and the epidural group received bupivacaine 0.25% 6 ml/h for intraoperative analgesia. As postoperative analgesia, the QLB group received repeated bilateral QLB and the epidural group received the decreased dosage of bupivacaine 0.125% 6 ml/h for 24 hours after surgery completion. The primary outcome was cumulative morphine requirement 24 hours postoperatively. Secondary outcomes included haemodynamic changes, postoperative pain scores, sensory block coverage, Bromage score, postoperative nausea and vomiting (PONV), and duration of urinary catheterisation. Result Postoperative cumulative morphine requirement, pain scores, PONV and Bromage score were not significantly different between the QLB and epidural group. The QLB affected T9–L2, continuous epidural block affected T8–L3 dermatomes. Duration of urinary catheterisation was shorter (p < 0.001) in the QLB group. The mean arterial pressure (MAP) measured at 24 hours after surgery was lower in the epidural group (p = 0.001). Conclusion The repeated QLB had similar cumulative 24-h morphine requirement, higher MAP, similar postoperative pain scores, similar PONV and degree of motor and sensory blockade, and shorter urinary catheterisation duration, compared with continuous epidural analgesia after transperitoneal laparoscopic nephrectomy. Trial Registration ClinicalTrial.gov NCT03520205 retrospectively registered on May 9th 2018.

scholarly journals A Randomised Controlled Trial on Analgesic Effect of Repeated Quadratus Lumborum Block Versus Continuous Epidural Analgesia Following Laparoscopic Nephrectomy

2019 ◽  
Author(s):  
Dita Aditianingsih ◽  
Pryambodho Pryambodho ◽  
Naufal Anasy ◽  
Aida Rosita Tantri ◽  
Chaidir Arif Mochtar
Keyword(s):  
Postoperative Pain ◽  
Epidural Analgesia ◽  
Laparoscopic Nephrectomy ◽  
Epidural Group ◽  
Pain Scores ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Continuous Epidural Analgesia ◽  
Randomised Controlled ◽  
Urinary Catheterisation

Abstract Background Epidural analgesia as the pain management for abdominal surgery has side effects such as paraesthesia, hypotension, haematomas, and impaired motoric of lower limbs. The quadratus lumborum block (QLB) has potential as an abdominal truncal block, however, the analgesic efficacy of QLB compared to epidural analgesia is unknown. This prospective randomised controlled study compared the effectiveness of QLB on postoperative opioid requirement and pain intensity with the epidural analgesia technique in transperitoneal laparoscopic nephrectomy. Methods Sixty-two patients underwent laparoscopic donor nephrectomy were randomised to receive QLB (n=31) or continuous epidural (n=31). The QLB group received bilateral QLB with 0.3–0.4 ml/kg bupivacaine 0.25% and the epidural group received bupivacaine 0.25% 6 ml/h for intraoperative analgesia. As postoperative analgesia, the QLB group received repeated bilateral QLB and the epidural group received the decreased dosage of bupivacaine 0.125% 6 ml/h for 24 hours after surgery completion. The primary outcome was cumulative morphine requirement 24 hours postoperatively. Secondary outcomes included haemodynamic changes, postoperative pain scores, sensory block coverage, Bromage score, postoperative nausea and vomiting (PONV), and duration of urinary catheterisation. Result Postoperative cumulative morphine requirement, pain scores, PONV and Bromage score were not significantly different between the QLB and epidural group. The QLB affected T9–L2, continuous epidural block affected T8–L3 dermatomes. Duration of urinary catheterisation was shorter (p < 0.001) in the QLB group. The mean arterial pressure (MAP) measured at 24 hours after surgery was lower in the epidural group (p = 0.001). Conclusion The repeated QLB had similar cumulative 24-hour morphine requirement, higher MAP, similar postoperative pain scores, similar PONV and degree of motor and sensory blockade, and shorter urinary catheterisation duration, compared with continuous epidural analgesia after transperitoneal laparoscopic nephrectomy. Trial Registration ClinicalTrial.gov NCT03520205 retrospectively registered on May 9th 2018. Keywords: epidural analgesia; laparoscopic nephrectomy; postoperative analgesia; patient-controlled analgesia; quadratus lumborum block.

scholarly journals A randomized controlled trial on analgesic effect of repeated Quadratus Lumborum block versus continuous epidural analgesia following laparoscopic nephrectomy

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Dita Aditianingsih ◽  
Pryambodho ◽  
Naufal Anasy ◽  
Aida Rosita Tantri ◽  
Chaidir Arif Mochtar
Keyword(s):  
Postoperative Pain ◽  
Epidural Analgesia ◽  
Urinary Catheter ◽  
Laparoscopic Nephrectomy ◽  
Epidural Group ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Continuous Epidural Analgesia

Abstract Background Epidural analgesia as the effective pain management for abdominal surgery has side effects such as paresthesia, hypotension, hematomas, and impaired motoric of lower limbs. The quadratus lumborum block (QLB) has potential as an abdominal truncal block, however, its analgesic efficacy has never been compared to epidural analgesia on laparoscopic nephrectomy. This prospective randomized controlled study compared the effectiveness of QLB with the epidural analgesia technique in relieving postoperative pain following transperitoneal laparoscopic nephrectomy. Methods Sixty-two patients underwent laparoscopic donor nephrectomy and were randomized to receive QLB (n = 31) or continuous epidural (n = 31). The QLB group received bilateral QLB using 0.25% bupivacaine and the epidural group received 6 ml/h of 0.25% bupivacaine for intraoperative analgesia. As postoperative analgesia, the QLB group received repeated bilateral QLB with the same dose and the epidural group received 6 ml/h of 0.125% bupivacaine for 24 h after surgery completion. The primary outcome was the 24-h cumulative morphine requirement after surgery. The secondary outcome was the postoperative pain scores. Sensory block coverage, hemodynamic changes, Bromage score, postoperative nausea-vomiting (PONV), paresthesia, and duration of urinary catheter usage were recorded and analyzed. Result The 24-h cumulative morphine requirement and pain scores after surgery were comparable between the QLB and epidural groups. The coverage of QLB was extended from T9 to L2 and the continuous epidural block was extended from T8 to L3 dermatomes. The mean arterial pressure (MAP) measured at 24 h after surgery was lower in the epidural group (p = 0.001). Bromage score, incidence of PONV, and paresthesia were not significantly different between the two groups. Duration of urinary catheter usage was shorter (p < 0.001) in the QLB group. Conclusion The repeated QLB had a similar 24-h cumulative morphine requirement, comparable postoperative pain scores and sensory blockade, higher postoperative MAP, a similar degree of motoric block, no difference in the incidence of PONV and paresthesia, and shorter urinary catheter usage, compared to the continuous epidural analgesia following transperitoneal laparoscopic nephrectomy. Trial registration ClinicalTrial.gov NCT03520205 retrospectively registered on May 9th 2018.

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