scholarly journals Effect of Pre-incisional Ultrasound-guided Quadratus Lumborum Block on Perioperative Analgesia and Inflammatory Responses in Transperitoneal Laparoscopic Nephrectomy: A Single-blinded, Randomised Control Trial

2019 ◽  
Author(s):  
Dita Aditianingsih ◽  
Besthadi Sukmono ◽  
Erika Adiwongso ◽  
Chaidir Mochtar
Keyword(s):  
Inflammatory Responses ◽  
Laparoscopic Nephrectomy ◽  
Randomised Control Trial ◽  
Ultrasound Guided ◽  
Perioperative Analgesia ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum

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

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.

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

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.

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

2019 ◽  
Author(s):  
Manhua Zhu ◽  
Yong Qi ◽  
Huijuan He ◽  
Jinfeng Lou ◽  
Qingqing Pei ◽  
...  
Keyword(s):  
Visceral Pain ◽  
Controlled Trial ◽  
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 effective in providing analgesia for lower abdominal and hip surgeries. The subcostal approach to transmuscular QLB is a novel technique that alleviates abdominal wall and visceral pain by blocking the anterior branch of T6-L1 and the sympathetic nerve. 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 anesthesia device 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) 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] ug vs 42.1 [11.6] ug, P=0.006). The RSS score did not differ between the two groups, and the BCS score of the QLB group at T1 and T2 time points was significantly higher than that of the C group (P＜0.05). The consumption of remifentanil intraoperatively and the number of patients requiring rescue analgesia was 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: Ultrasound-guided subcostal approach to QLB is an effective analgesic technique in patients undergoing laparoscopic nephrectomy as it reduces the consumption of sufentanil postoperatively.

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