Continuous basal infusion versus programmed intermittent bolus for quadratus lumborum block after laparoscopic colorectal surgery: a randomized-controlled, double-blind study

Abstract

Background Quadratus lumborum block (QLB) has recently attracted attention as a part of multimodal analgesia after abdominal surgery. It has been shown that programmed intermittent boluses of local anesthetic can produce better analgesia and wider sensory blockade compared with continuous basal infusion with some peripheral nerve blocks. The present study was conducted to see if this theory holds true for QLB in patients undergoing laparoscopic colorectal surgery. Methods Fifty patients undergoing laparoscopic colorectal surgery were divided into 2 groups to receive continuous basal infusion (group C) or programmed intermittent boluses (group PIB) of local anesthetic. After surgery, patients received the posterior approach to QLB and a catheter was introduced bilaterally. Patients in group C received a continuous infusion of 0.15% levobupivacaine at 3 ml/h, and those in group PIB received a bolus of 12 ml every 4 h. All patients received intravenous patient-controlled analgesia using fentanyl. Measurements were taken for cumulative fentanyl consumption, pain scores, cutaneous sensory blockade, analgesic requirements, and adverse events for 46 h. Results The primary outcome of cumulative fentanyl consumption at 22 h showed no significant difference between the groups [group C: 11.9 (11.2-15.5) µg/kg (median (interquartile range)) and group PIB: 12.3 (11.6-15.3), p = 0.473]. Pain scores, demands for rescue analgesics, and spread of cutaneous sensory blockade were similar for the two groups. Conclusion Programmed intermittent boluses of local anesthetic for continuous QLB did not produce better analgesia or wider sensory blockade compared with continuous basal infusion in patients undergoing laparoscopic colorectal surgery.

PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery

“…When comparing the QLB to TAP block, Deng et al 81 found opioid-sparing, and Huang et al 82 reported marginal analgesic and opioid-sparing effects in favour of QLB. Aoyama et al 83 found no difference in analgesic effect when QLB was performed as a continuous infusion versus programmed intermittent bolus infusion.…”

“…Some studies had more than two relevant study arms. These were separately listed for each relevant comparison, making the sum of studies in the following listing higher than the number of studies included: seven studies investigating adjuvant systemic analgesics, 39–45 three studies investigating varying degrees of neuromuscular blockade, 46–48 seven studies investigating intravenous lidocaine, 43,49–54 six studies investigating epidural analgesia, 55–60 four studies investigating spinal opioids, 55,61–63 twenty-eight studies investigating truncal nerve blocks, 53,58–60,64–87 seven studies investigating wound infiltration, 54,57,72–74,88,89 four studies investigating intraperitoneal local anaesthetics (IPLA) 90–93 and seventeen studies investigating surgical techniques 94–110 . Supplemental Table 1, http://links.lww.com/EJA/A901 lists the summary of key results from studies evaluating systemic analgesics, systemic analgesic adjuncts, regional analgesia and surgical procedures used to support the recommended interventions in patients after laparoscopic colectomy.…”

Ultrasound-guided posterior quadratus lumborum block can reduce postoperative opioid consumption and promote rapid recovery in patients undergoing sutureless laparoscopic partial nephrectomy: A triple-blind, randomized, controlled study

“…Prolonging the analgesic duration of QLB is favorable for patients. Several studies (23)(24)(25) have shown that various adjuvants (such as dexmedetomidine, dexamethasone) or intravenous drugs (lidocaine, ketamine) used in conjunction with QLB can prolong the analgesic time of QLB, and the placement of catheters for sustained analgesia is also an option (26). However, the mechanisms behind them and their broad clinical applications still require further exploration in the future.…”