EFFICACY OF QUADRATUS LUMBORUM BLOCKS IN ROBOTIC NEPHRECTOMY- A RETROSPECTIVE REVIEW.

Abstract Abstract: With the implementation of enhanced recovery pathways (ERAS) in kidney surgeries, regional techniques are being considered an important aspect of multimodal analgesia. Abdominal blocks such as quadratus lumborum block (QLB) have been used as an effective analgesic in abdominal surgeries, however their efficacy in kidney surgery remains unknown. To our best knowledge, there are no clinical studies exploring the relationship between QLBs and post-operative opioid consumption in robotic laparoscopic nephrectomy. Study Objectives: Assess analgesic efficacy between QLB and post-operative opioid consumption in robotic laparoscopic nephrectomy. Design and Setting: A retrospective chart review was conducted by querying the electronic medical record system of 2,200 bed tertiary academic hospital center in New York City. Outcomes: The primary measured outcome was postoperative morphine milli equivalent (MME) consumption for the first 24 hours. Secondary outcomes include intra-operative MME, as well as postoperative pain scores measured on a visual analogue scale (VAS) scale at 2, 6, 12, 18, and 24 hours post-operatively. Results: The mean total post-operative MME in the pQLB group was 11 [4, 18] and 15 [5.6, 28] in the control group (p =.001). There was a significant reduction in intra-operative MME in the QLB group in comparison to the control group. This reduction was not seen in post-operative MME. There was no significant difference in pain scores at any of the measured time points up to 24 hours post-operatively. Conclusion: Our study provides compelling support that ultrasound guided QLB significantly decreased intra operative opioid requirements but did not have the same effect on postoperative opioid requirements following robotic kidney surgeries in the context of an ERAS pathway. Keywords: Kidney surgeries, Robotic laparoscopic nephrectomy, quadratus lumborum block (QLB), enhanced recovery pathways (ERAS)

Download Full-text

Transmuscular quadratus lumborum block reduces opioid consumption and prolongs time to first opioid demand after laparoscopic nephrectomy

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101745 ◽

2020 ◽

Vol 46 (1) ◽

pp. 18-24

Author(s):

Mette Dam ◽

Christian Hansen ◽

Troels Dirch Poulsen ◽

Nessn Htum Azawi ◽

Gunnar Hellmund Laier ◽

...

Keyword(s):

Intervention Group ◽

Oral Morphine ◽

Analgesic Efficacy ◽

Multimodal Analgesia ◽

Opioid Consumption ◽

Laparoscopic Nephrectomy ◽

Hospital Length Of Stay ◽

Control Group ◽

Pain Scores ◽

Quadratus Lumborum

BackgroundRobotic and hand-assisted laparoscopic nephrectomies are often associated with moderate to severe postoperative pain. The aim of the current study was to investigate the analgesic efficacy of the transmuscular quadratus lumborum (TQL) block for patients undergoing robotic or hand-assisted laparoscopic nephrectomy.MethodsFifty patients were included in this single-center study. All patients were scheduled for elective hand-assisted or robotic laparoscopic nephrectomy under general anesthesia. Preoperatively, patients were randomly allocated to TQL block bilaterally with ropivacaine 60 mL 0.375% or 60 mL saline and all patients received standard multimodal analgesia and intravenous patient-controlled analgesia. Primary outcome was postoperative oral morphine equivalent (OME) consumption 0–12 hours. Secondary outcomes were postoperative OME consumption up to 24 hours, pain scores, time to first opioid, nausea/vomiting, time to first ambulation and hospital length of stay (LOS).ResultsMean (95% CI) OME consumption was significantly lower in the intervention group at 12 hours after surgery 50 (28.5 to 71.5) mg versus control 87.5 (62.7 to 112.3) mg, p=0.02. At 24 hours, 69.4 (43.2 to 95.5) mg versus 127 (96.7 to 158.6) mg, p<0.01. Time to first opioid was significantly prolonged in the intervention group median (IQR) 4.4 (2.8–17.6) hours compared with 0.3 (0.1–1.0) hours in the control group, p<0.001. No significant intergroup differences were recorded for time to first ambulation, pain scores, nausea/vomiting nor for LOS.ConclusionPreoperative bilateral TQL block significantly reduced postoperative opioid consumption by 43% and significantly prolonged time to first opioid.Trial registration numberNCT03571490.

Download Full-text

Ultrasound-guided Quadratus Lumborum Block for Perioperative Analgesia in Robot-assisted Partial Nephrectomy: A Randomized Controlled Trial

10.21203/rs.3.rs-19158/v1 ◽

2020 ◽

Author(s):

Jielan Lai ◽

Quehua Luo ◽

Yanling Liu ◽

Ruifeng Xue ◽

Yang Huang ◽

...

Keyword(s):

Partial Nephrectomy ◽

Case Reports ◽

Controlled Trial ◽

Opioid Consumption ◽

Control Group ◽

Robot Assisted ◽

Early Recovery ◽

Quadratus Lumborum Block ◽

Quadratus Lumborum ◽

Significant Difference

Abstract Background Recently, several case reports and limited randomized studies have shown that the quadratus lumborum block (QLB) is effective in providing pain relief after intra-abdominal and retroperitoneal operations. Robot-assisted partial nephrectomy (RAPN) has also been proposed as a promising operative treatment for renal carcinoma because it enables early recovery and ambulation. Therefore, we aimed to evaluate the analgesic and opioid-sparing effects of a single-injection QLB, which may paly an important role on early recovery program in RAPN.MethodsFifty-six patients undergoing elective RAPN under general anesthesia were randomised to two equally sized groups. Patients were randomly allocated to receive unilateral QLB (n=28) with 0.375% bupivacaine 0.5 mL/kg (QLB group) or a conventional scheme (n=28) group (Control group). The QLB technique was performed as first described by Blanco, termed QLB2. The primary outcome was the visual analogue scale (VAS) scores with movement at 6 hours postoperatively. The secondary endpoints were the morphine consumption at different time-period after surgery, morphine-related side effects and assessment of postoperative rehabilitation. ResultsBoth VAS pain score and cumulative opioid consumption were significantly lower in the QLB group at 6 hours after surgery as compared with the control group (all P<0.05). There was significant difference in pain scores at any other time-point except at 4 hours on movement and 48 hours at rest. However, no significant difference was observed in 12-48 hours cumulative opioid consumption, and in the duration of PACU and hospital stay between the two groups. The patient recovery scores was significantly higher in the QLB group.ConclusionsSingle-injection pre-emptive QLB applied to RAPN was effective and provided satisfactory analgesia and opioids-sparing in combination with a typical patient-controlled analgesia. In addition, it may provide an effective technique for early recovery in perioperative period.

Download Full-text

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

10.21203/rs.2.9494/v2 ◽

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.

Download Full-text

Analgesic effect of the ultrasound-guided subcostal approach to transmuscular quadratus lumborum block in patients undergoing laparoscopic nephrectomy: a randomized controlled trial

10.21203/rs.2.9830/v3 ◽

2019 ◽

Author(s):

Manhua Zhu ◽

Yong Qi ◽

Huijuan He ◽

Jinfeng Lou ◽

Qingqing Pei ◽

...

Keyword(s):

Controlled Trial ◽

Postoperative Nausea And Vomiting ◽

Laparoscopic Nephrectomy ◽

Control Group ◽

Intestinal Function ◽

Ultrasound Guided ◽

Rescue Analgesia ◽

Quadratus Lumborum Block ◽

Quadratus Lumborum ◽

Number Of Patients

Abstract Background: Quadratus lumborum block (QLB) is an effective analgesia that lowers opioid consumption after lower abdominal and hip surgeries. The subcostal approach to transmuscular QLB is a novel technique that can provide postoperative analgesia by blocking more dermatomes. The aim of this study is to evaluate the efficacy and viability of subcostal approach to QLB after laparoscopic nephrectomy. Methods: Sixty patients who underwent laparoscopic nephrectomy were randomly divided into the subcostal approach to QLB group (QLB group, n=30) and the control group (C group, n=30). All patients underwent ultrasound-guided subcostal approach to QLB in an ipsilateral parasagittal oblique plane at the L1–L2 level. The QLB group received 0.4 cc/kg of 0.3% ropivacaine, and the C group received 0.4 cc/kg of 0.9% saline. Postoperatively, a patient-controlled intravenous analgesic pump with sufentanil was attached to all the patients. The primary outcome was sufentanil consumption within the first 24 h after surgery. The secondary outcomes included the Ramsey sedation scale (RSS) scores and Bruggemann comfort scale (BCS) scores 6 h (T1), 12 h (T2), and 24 h (T3) after surgery, intraoperative remifentanil consumption, number of patients requiring rescue analgesia, time to recovery of intestinal function, mobilization time after surgery, and presence of side effects. Results: Sufentanil consumption within the first 24 h after surgery was significantly lower in the QLB group than in the C group (mean [standard deviation]: 34.1 [9.9] μg vs 42.1 [11.6] μg, P=.006). The RSS scores did not differ between the two groups, and the BCS scores of the QLB group at T1 and T2 time points was significantly higher than those of the C group(P＜0.05). The consumption of remifentanil intraoperatively and the number of patients requiring rescue analgesia were significantly lower in the QLB group (P＜0.05). Time to recovery of intestinal function and mobilization time after surgery were significantly earlier in the QLB group (P＜0.05). The incidence of postoperative nausea and vomiting was significantly lower in the QLB group (P＜0.05). Conclusions: The ultrasound-guided subcostal approach to QLB is an effective analgesic technique in patients undergoing laparoscopic nephrectomy as it reduces the consumption of sufentanil postoperatively.

Download Full-text

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

10.21203/rs.2.9494/v1 ◽

2019 ◽

Author(s):

Dita Aditianingsih ◽

Pryambodho Pryambodho ◽

Naufal Anasy ◽

Aida Rosita Tantri ◽

Chaidir Arif Mochtar

Keyword(s):

Epidural Analgesia ◽

Pain Intensity ◽

Postoperative Analgesia ◽

Laparoscopic Nephrectomy ◽

Epidural Group ◽

Pain Scores ◽

Quadratus Lumborum Block ◽

Urethral Catheterisation ◽

Quadratus Lumborum ◽

Continuous Epidural Analgesia

Abstract Background Epidural analgesia as the pain management for abdominal surgery has unfavorable side effects. 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 randomized 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 undergoing 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 postoperative pain scores, sensory block coverage, Bromage score, postoperative nausea and vomiting (PONV), and duration of urethral catheterisation. Hemodynamic parameters were recorded. 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 urethral catheterisation was shorter (p < 0.001) in the QLB group. The MAP measured at 24 hours after surgery was lower in the epidural group (p = 0.001). Conclusion The repeated QLB had similar cumulative morphine requirement and pain intensity, shorter uretheral catheterization duration, and higher MAP, 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.

Download Full-text

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

Journal of Clinical Medicine ◽

10.3390/jcm10204632 ◽

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.

Download Full-text

Opioid Requirements in Laparoscopic Colectomies: Do Enhanced Recovery After Surgery Protocols Make a Difference?

The American Surgeon ◽

10.1177/0003134820956312 ◽

2020 ◽

pp. 000313482095631

Author(s):

Samer Kawak ◽

Joanna F. Wasvary ◽

Matthew A. Ziegler

Keyword(s):

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Tertiary Care ◽

Patient Characteristics ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Care Hospital ◽

Pain Scores ◽

Enhanced Recovery Pathways ◽

Recovery Pathways

Background With the growing opioid epidemic and recent focus on the quantity of opioids prescribed at discharge after surgery, enhanced recovery pathways provide another tool to counteract this epidemic. The aim of this current study is to analyze the differences in opioid requirements and pain scores in the immediate postoperative period for patients who underwent laparoscopic colectomies before and after the implementation of enhanced recovery after surgery (ERAS) protocols. Materials and Methods This study is a retrospective review of patients and was conducted at an academically affiliated tertiary care hospital. In patients undergoing elective laparoscopic colectomies before December 1, 2013-July 31, 2015 and after September 1, 2015-May 31, 2018, the implementation of enhanced recovery pathways was included. The primary end point was opioid consumption from the end of surgery until 48 hours after surgery. Secondary end points included pain scores, surgery length of time, and hospital length of stay after surgery. Results A total of 242 patients (122 pre- and 120 postimplementation) were analyzed. Patient characteristics were similar between groups. Pain scores were higher in the preimplementation patients for postoperative day (POD) 0 scores ( P = .019). There was a decrease in the morphine milligram equivalents (MME) on POD 0-2 for the postimplementation patients. This decrease resulted in a 61% reduction in opioid requirements after implementation of ERAS protocols (32 vs. 12.5 MME, P < .0001). Discussion Enhanced recovery after surgery protocols can reduce opioid requirements after elective laparoscopic colectomies without negatively affecting pain scores.

Download Full-text

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

10.21203/rs.2.9494/v3 ◽

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.

Download Full-text

Analgesic effect of the ultrasound-guided subcostal approach to transmuscular quadratus lumborum block in patients undergoing laparoscopic nephrectomy: a randomized controlled trial

10.21203/rs.2.9830/v2 ◽

2019 ◽

Author(s):

Manhua Zhu ◽

Yong Qi ◽

Huijuan He ◽

Jinfeng Lou ◽

Qingqing Pei ◽

...

Keyword(s):

Controlled Trial ◽

Postoperative Nausea And Vomiting ◽

Laparoscopic Nephrectomy ◽

Control Group ◽

Intestinal Function ◽

Ultrasound Guided ◽

Rescue Analgesia ◽

Quadratus Lumborum Block ◽

Quadratus Lumborum ◽

Number Of Patients

Download Full-text

The Effect of Ultrasound Guided Superficial Cervical Plexus Block on Postoperative Opioid Consumption in Patients Undergoing Anterior Cervical Discectomy and Fusion Surgery: A Prospective, Randomized Controlled Study

Journal of Anesthesiology and Reanimation Specialists’ Society ◽

10.5222/jarss.2021.15238 ◽

2021 ◽

Author(s):

İrem Ateş ◽

Erkan Cem Çelik ◽

Ufuk DEmir ◽

Muhammed Enes Aydın ◽

Ali Ahiskalıoğlu

Keyword(s):

Opioid Consumption ◽

Anterior Cervical Discectomy ◽

Controlled Study ◽

Control Group ◽

Ultrasound Guided ◽

Rescue Analgesia ◽

Cervical Discectomy ◽

Pain Scores ◽

Significant Difference ◽

Vas Scores

INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) surgery is a procedure that can cause moderate pain in the postoperative period. Superficial cervical block (SCB) is a regional anesthesia technique that can provide analgesia during and after surgery. The aim of this study is to investigate the effect of ultrasound-guided SCB block on pain scores and postoperative opioid consumption in patients undergoing ACDF surgery. METHODS: 48 patients planned to undergo single or two levels of ACDF surgery were randomly divided into two groups, SCB and Control (C). Ultrasonography (USG) guided SCB was performed in the SCB group (n=24) with 10 mL of 0.25% bupivacaine. No attempt was made to the control group (n=24) before the operation. Intravenous 50 mg dexketoprofen was administered to both groups half an hour before the end of the operation and at the 12th hour postoperatively. Patient controlled analgesia (PCA) device containing fentanyl was initiated. Postoperative visual analog scale (VAS) scores, opioid consumption, need for rescue analgesia and side effects were recorded. RESULTS: There was no statistically significant difference between the groups in terms of demographic data, anesthesia and surgery times. Compared to the control group, VAS scores were statistically low at all measurement times in the SCB group (p <0.05). The 24-hour total opioid consumption was statistically significantly higher in the control group than in the SCB group (375.83±235.96 µg vs. 112.50±102.41 µg, respectively p<0.001). The need of rescue analgesia was statistically higher in the control group than the SCB group (12/24 vs. 0/24, respectively, p <0.001). DISCUSSION AND CONCLUSION: We believe that USG-guided SCB can be an effective component of the multimodal analgesia protocol by reducing opioid consumption and pain scores in patients undergoing ACDF surgery.

Download Full-text