Background: There are many surgical and anesthetic factors that affect pain and the endocrine–metabolic response to trauma. The ability of anesthetic agents and neuronal blockade to modify the response to surgical trauma has been widely studied in the last few years. Objective: To evaluate if the anterior quadratus lumborum block contributes to improved surgical recovery, using as parameters analgesia, pulmonary function and neuroendocrine response to trauma. Methods: We carried out a prospective, randomized, controlled, and blinded study, in which 51 patients scheduled for laparoscopic cholecystectomy. Patients were randomly selected and assigned to 2 groups. The control group received balanced general anesthesia and venous analgesia, and the intervention group was treated under general, venous analgesia and anterior quadratus lumborum block. The parameters evaluated were: demographic data, postoperative pain, respiratory muscle pressure and inflammatory response to surgical stress with the plasma dosage of IL-6 (Interleukin 6), CRP (C-Reactive protein) and cortisol. Results: Anterior quadratus lumborum block induced the slowing of IL-6 cytokine production and a decrease in cortisol release. This effect was accompanied by the significant reduction of postoperative pain scores. Conclusion: Anterior quadratus lumborum block is an important strategy for analgesia in abdominal laparoscopic surgery and contributes to reducing the inflammatory response to surgical trauma with an early return of preoperative baseline physiological functions.
Background Laparoscopy revolutionizing digital and robotic technology for surgical practice. The ability of anesthetic agents and neuronal blockade to modify the response to surgical trauma has been widely studied in the last few years. Objectives evaluate if Anterior Quadratus Lumborum Block contributes to attenuate surgical repercussions, having as primary parameters analgesia and secondary the pulmonary function and neuroendocrine response to trauma. Methods prospective, controlled, Double-blind study, in which 51 patients scheduled for eletive laparoscopic cholecystectomy were randomly selected and distributed into 2 groups. Control group received general anesthesia, and the intervention group was submitted to general anesthesia plus Anterior Quadratus Lumborum Block. The parameters evaluated were: postoperative pain, respiratory muscle pressure, and inflammatory response to surgical stress with the plasma dosage of Interleukin 6, C-Reactive protein and cortisol. The following situations were excluded: refusal to participate in the study; body mass index greater than or equal to 40, peripheral neuropathies, coagulopathies or hypersensitivity to drugs used; infection at the puncture site; fever, purities; dementia or other states that would prevent the adequate understanding of the use of the numeric-verbal scale of pain; immunological diseases, diabetes, malignant neoplasia, use of opioids or anti-inflammatory drugs in the preoperative period; antidepressants and anticonvulsants, conversion open surgery, re-exploration and hospital stay. Results Slowed Interleukin 6 cytokine production and decrease in cortisol release, accompanied by significant attenuation of surgical repercussion on lung function and significant reduction in postoperative pain scores and consumption of pain medication. Conclusion An important strategy for analgesia in abdominal laparoscopic surgery.
Aim: Digital and robotic technology applications in laparoscopic surgery have revolutionized routine cholecystectomy. Insufflation of the peritoneal space is vital for its safety but comes at the cost of aseptic ischemia-reperfusion-induced intraabdominal organ compromise before the return of physiologic functions. Dexmedetomidine in general anesthesia promotes controlling the response to trauma by altering the neuroinflammatory reflex. This strategy may improve clinical outcomes in the postoperative period by reducing postoperative narcotic use and lowering the risk of subsequent addiction. In this study, the authors aimed to evaluate dexmedetomidine’s therapeutic and immunomodulatory potential on perioperative organ function. Methods: Fifty-two patients were randomized 1:1: group A—sevoflurane and dexmedetomidine (dexmedetomidine infusion [1 µg/kg loading, 0.2–0.5 µg/kg/h maintenance dose]), and group B—sevoflurane with saline 0.9% infusion as a placebo control. Three blood samples were collected: preoperatively (T0 h), 4–6 h after surgery (T4–6 h), and 24 h postoperatively (T24 h). The primary outcome was the level analysis of inflammatory and endocrine medications. Secondary outcome measures were the time to return to normal preoperative hemodynamic parameters, spontaneous ventilation, and postoperative narcotic requirements to control surgical pain. Results: A reduction of Interleukin 6 was found at 4–6 h after surgery in group A with a mean of 54.76 (27.15–82.37; CI 95%) vs. 97.43 (53.63–141.22); p = 0.0425) in group B patients. Systolic and diastolic blood pressure and heart rate were lower in group A patients, who also had a statistically significantly lower opioid consumption in the first postoperative hour when compared to group B patients (p < 0.0001). We noticed a similar return to spontaneous ventilation pattern in both groups. Conclusions: Dexmedetomidine decreased interleukin-6 4–6 h after surgery, likely by providing a sympatholytic effect. It provides good perioperative analgesia without respiratory depression. Implementing dexmedetomidine during laparoscopic cholecystectomy has a good safety profile and may lower healthcare expenditure due to faster postoperative recovery.
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