Analgesic Efficacy of Quadratus Lumborum Block in Patients Undergoing Nephrectomy: A Systematic Review and Meta-Analysis

Abstract

Objective To evaluate the analgesic efficacy of quadratus lumborum block (QLB) in adults undergoing nephrectomy. Design Systematic review and meta-analysis. Patients Adult patients (≥ 18 years) received nephrectomy under general anesthesia. Methods We searched PubMed, Embase, the Cochrane Library, and Web of Science on January 10, 2022, including randomized controlled trials (RCTs) that evaluated the analgesic efficacy of QLB for patients undergoing nephrectomy. Results A total of 12 RCTs (N = 821 patients) were included in the study. Compared with the non-block, single-shot QLB reduced the postoperative opioid consumption (mean difference [MD], -8.37 mg intravenous morphine equivalent; 95% CI, -12.19 to -4.54 mg) and pain scores at 2 h, 6 h, 12 h, and 24 h at rest and during movement after nephrectomy. Single-shot QLB also prolonged the time to first analgesic request (MD, 6.44 h; 95% CI, 2.23 to 10.65 h), and shortened the length of hospital stay (MD, -0.32 d; 95% CI, -0.55 to -0.09 d) and decreased the incidence of postoperative nausea and vomiting (risk ratio, 0.48; 95% CI, 0.36 to 0.65). Compared with continuous epidural anesthesia, repeated QLB may provide comparable postoperative analgesic benefits. Conclusions Single-shot QLB provided a statistically significant, but clinically-small improvement in postoperative analgesia and recovery for patients undergoing nephrectomy. The QLB would be beneficial as part of multimodal analgesia. Future research may need to determine which approach of QLB is superior for postoperative analgesia after nephrectomy.

Intraoperative and Postoperative Opioid-Sparing Effect of Ultrasound Guided Quadratus lumborum Block versus Erector Spinae Plane Block in Renal Surgeries under General Anesthesia

“…Unlikely, Tulgar et al (19) had shown that in the block group there was no significant pain relief in 6.5% of patients that underwent different abdominal surgeries compared to non-block group. As regards QLB, the current results are consistent with Wang et al (20) , as they found reduced postoperative intravenous opioid given and pain results both during static and during dynamic state after nephrectomy compared to control group. They also stated that a singleshot QLB increased time for given analgesia after surgery, decrease time of recovery and lower complications including PONV.…”