Comparison of postoperative pain between laparoscopic and robot-assisted partial nephrectomies for renal tumors

Jin, Seok-Joon; Park, Jun-Young; Kim, Doo-Hwan; Yoon, Syn-Hae; Kim, Eunkyul; Hwang, Jai-Hyun; Song, Cheryn; Kim, Young‐Kug

doi:10.1097/md.0000000000007581

Cited by 10 publications

(9 citation statements)

References 17 publications

(20 reference statements)

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“… 1 , 2 However, despite less surgical trauma with LRS compared with open surgery, moderate-to-severe pain remains in the early postoperative period. 3 , 4 Adequate pain control is important for rapid recovery after surgery. Although opioids are the most commonly used analgesics, they bring side effects such as postoperative nausea and vomiting, gastro-intestinal ileus and respiratory depression.…”

Section: Introductionmentioning

confidence: 99%

Analgesic efficacy of two approaches of ultrasound-guided quadratus lumborum block for laparoscopic renal surgery

Xu²,

Li³

et al. 2021

European Journal of Anaesthesiology

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BACKGROUND Moderate-to-severe pain exists in the early postoperative period after laparoscopic renal surgery. OBJECTIVE We investigated the analgesic effect of quadratus lumborum block (QLB) via two approaches in patients undergoing laparoscopic renal nephrectomy. DESIGN A randomised controlled trial. SETTING An academic tertiary care hospital in Beijing, China. PARTICIPANTS Ninety-six patients aged 18 to 70 years who were scheduled for elective laparoscopic radical or partial nephrectomy. INTERVENTIONS Eligible patients were allocated randomly to a control group (no block), lateral QLB group or posterior QLB group. Ultrasound-guided QLB was performed via either the lateral or posterior approach with 30 ml of 0.4% ropivacaine before surgery. MAIN OUTCOME MEASURES The primary outcome was sufentanil equivalent consumption within 24 h. Among secondary outcomes, somatic and visceral pain intensity at rest and on coughing were assessed with a numerical rating scale (where 0 = no pain and 10 = the worst pain) until 24 h postoperatively. RESULTS Sufentanil equivalent consumption did not differ among the three groups (118 ± 36 μg in the control group, 115 ± 47 μg in the lateral QLB group and 119 ± 40 μg in the posterior QLB group; P = 0.955). However, both somatic (lateral QLB vs. control, median difference −1, P < 0.001 at rest and −2 to −1, P < 0.001 on coughing; posterior QLB vs. control, −1, P < 0.001 at rest and −2 to −1, P < 0.001 on coughing) and visceral pain scores (lateral QLB vs. control, −1 to 0, P < 0.001 at rest and −1, P < 0.001 on coughing; posterior QLB vs. control, −1 to 0, P < 0.001 at rest and −2 to −1, P < 0.001 on coughing) were significantly lower in the two QLB groups than in the control group. CONCLUSION For patients undergoing laparoscopic renal surgery, a pre-operative single-shot QLB via the lateral or posterior approach did not decrease opioid consumption, but improved analgesia for up to 24 h after surgery. TRIAL REGISTRATION www.chictr.org.cn identifier: ChiCTR1800019883.

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Section: Introductionmentioning

confidence: 99%

Analgesic efficacy of two approaches of ultrasound-guided quadratus lumborum block for laparoscopic renal surgery

Xu²,

Li³

et al. 2021

European Journal of Anaesthesiology

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“…They demonstrated that the morphine consumption and pain scores at 24 hours after surgery were comparable. A propensity score matching analysis has reported that postoperative pain was not significantly different between the different operation mode (robot-assisted partial nephrectomy vs laparoscopic partial nephrectomy) [35]. A third arm in our study may have been beneficial in discerning whether the QLB has assistant effects when compared to"no block" pattern.…”

Section: Discussionmentioning

confidence: 70%

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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“…Jin et al reported no significant difference in postoperative pain between patients who underwent RAPN and laparoscopic partial nephrectomy. The NRS scores in the RAPN group anesthetized by general anesthesia only were 5.9, 3.5, and 2.8 at POD 0, 1, and 2, respectively [11].…”

Section: Discussionmentioning

confidence: 87%

Anesthetic management using a combination of anterior quadratus lumborum block and erector spinae plane block for robot-assisted partial nephrectomy: two case reports

et al. 2020

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Background: There has been increasing attention regarding quadratus lumborum block (QLB) and erector spinae plane block (ESPB) as effective truncal blocks. There have been reports of combined QLB and ESPB usage in hip surgery resulting in a symbiotic increase in effectiveness. However, there have been no reports regarding robotassisted partial nephrectomy (RAPN), which requires multiple port holes ranging from near the xiphoid process to below the umbilicus. We hypothesized that the combined use of QLB and ESPB was an option for anesthesia and analgesia during RAPN. Case presentation: Anterior QLB and ESPB were applied to two patients undergoing scheduled RAPN. With intravenous patient-controlled analgesia, the post-surgery numerical rating scale scores were < 3/10 at rest and < 5/10 upon movement, throughout the perioperative time. Conclusions: The combination of QLB and ESPB could be an option for the postoperative analgesia in RAPN.

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Comparison of postoperative pain between laparoscopic and robot-assisted partial nephrectomies for renal tumors

Cited by 10 publications

References 17 publications

Analgesic efficacy of two approaches of ultrasound-guided quadratus lumborum block for laparoscopic renal surgery

Analgesic efficacy of two approaches of ultrasound-guided quadratus lumborum block for laparoscopic renal surgery

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

Anesthetic management using a combination of anterior quadratus lumborum block and erector spinae plane block for robot-assisted partial nephrectomy: two case reports

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