A Review of the Quadratus Lumborum Block and ERAS

Akerman, Michael; Pejčić, Nada; Veličković, Ivan

doi:10.3389/fmed.2018.00044

Cited by 124 publications

(125 citation statements)

References 68 publications

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“…Technically, full visualization of the needle tip during the injection is essential due to the closeness of the administration site to the abdominal structures. Since the frequency of using local anesthesia is higher than peripheral nerve block administration, it has been reported that this may cause potential local anesthetic systemic toxicity (LAST) related complications due to systemic absorption [30]. Although it was found that local anesthetic levels after QLB did not reach a toxic dose, we think that further studies are needed to quantify the potential risk [21].…”

Section: Discussionmentioning

confidence: 84%

Ultrasound-guided anterior quadratus lumborum block for postoperative pain after percutaneous nephrolithotomy: a randomized controlled trial

Ökmen

2020

Korean J Anesthesiol

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Background:The quadratus lumborum block (QLB), which is reported to provide analgesia to the abdominal region, is a newly defined fascial plane block method. The present study aimed to investigate the effect of ultrasound guided anterior QLB on the postoperative pain scores after percutaneous nephrolithotomy (PNL). Methods: In this prospective, randomized, controlled single-blind study, 60 patients with PNL operations were randomized into 2 groups. In Group B (n = 30): anterior QLB+ intravenous patient-controlled analgesia (PCA) morphine and in Group C (n = 30): intravenous PCA morphine. Outcome measures were included for visual analog scale (VAS) scores and cumulated consumption for 24 hours postoperatively. Adverse effects, additional analgesic requirement, and intraoperative opioid requirement were recorded. Results: The mean values of the quantity of cumulated morphine used at the 6th, 12th, and 24th hours were found to be statistically significantly lower in Group B (P < 0.05). The VAS scores were found to be statistically significantly lower in Group B (P < 0.05). There were no statistically significant differences in the rate of adverse effects, additional analgesic requirement, and intraoperative opioid requirement between the groups. Conclusions:The study results suggest that anterior QLB is an effective treatment option for postoperative analgesia of PNL.

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Section: Discussionmentioning

confidence: 84%

Ultrasound-guided anterior quadratus lumborum block for postoperative pain after percutaneous nephrolithotomy: a randomized controlled trial

Ökmen

2020

Korean J Anesthesiol

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“…We felt that the aforementioned analgetic scheme has remarkable efficacy in pain relief, especially for patients who are involved in the enhanced recovery programs. Therefore, this study focused on whether the QLB may enable an increased analgesic effect and the role it plays in the combination of a typical multi-modal analgesia [33,34]. A recent study by Aditianingsih et al…”

Section: Discussionmentioning

confidence: 99%

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

Lai

Luo

Liu

et al. 2020

Preprint

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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.

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“…The mechanism of action of QLB is not entirely clear and the spread of local anaesthetic is quite varied according to technique. 17 Hence, clinicians should be aware of lower leg muscle weakness and sensory changes during post-anaesthesia care after performing QLB, and patients should be informed of the possibility of both numbness and weakness as potential side-effects as part of their preoperative consent. Some limitations should be considered in this study.…”

Section: Discussionmentioning

confidence: 99%

Effect of posterior quadratus lumborum blockade on the quality of recovery after major gynaecological laparoscopic surgery: A randomized controlled trial

Fujimoto

Irie

Mihara

et al. 2019

Anaesth Intensive Care

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Bilateral quadratus lumborum blockade (QLB) using ultrasound guidance has been introduced as an abdominal truncal block to improve postoperative analgesia and quality of recovery (QoR) after abdominal surgery, but efficacy remains controversial. The primary aim of this study was to evaluate the efficacy of posterior QLB on the postoperative QoR, and secondarily to evaluate postoperative pain after gynaecological laparoscopic surgery (LS). This study was a single-centre randomized controlled trial. QLB group patients underwent bilateral posterior quadratus lumborum injections with 25–30 mL of 0.25% levobupivacaine after induction of general anaesthesia; the control group underwent no block. Both groups were administered fentanyl-based intravenous patient-controlled analgesia postoperatively. The postoperative QoR was measured using the Quality of Recovery 40 (QoR-40) questionnaire score; postoperative pain was evaluated using the visual analogue scale (VAS) and the cumulative postoperative fentanyl dose. Thirty-one and 29 patients were randomised to the QLB and control groups, respectively. The intraoperative remifentanil dosage was significantly less in the QLB group. The median (interquartile range) for the QoR-40 score was not different between the groups: 154 (133–168) in the QLB group and 158 (144–172) in the control group. There were no statistically significant differences in secondary outcome variables. Single-shot QLB did not improve the QoR or postoperative pain in patients managed by multimodal analgesia after gynaecological LS.

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A Review of the Quadratus Lumborum Block and ERAS

Cited by 124 publications

References 68 publications

Ultrasound-guided anterior quadratus lumborum block for postoperative pain after percutaneous nephrolithotomy: a randomized controlled trial

Ultrasound-guided anterior quadratus lumborum block for postoperative pain after percutaneous nephrolithotomy: a randomized controlled trial

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

Effect of posterior quadratus lumborum blockade on the quality of recovery after major gynaecological laparoscopic surgery: A randomized controlled trial

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