Dexmedetomidine Added to Bupivacaine versus Bupivacaine in Transincisional Ultrasound-Guided Quadratus Lumborum Block in Open Renal Surgeries: A Randomized Trial

Abstract

Background: General anesthesia (GA) is the preferred anesthetic modality for open renal surgeries to ensure a patent airway while the patient is in the lateral decubitus position. However, these surgeries are usually accompanied by severe postoperative pain with increased requirements for multimodal pain management strategies. Regional blocks provide better postoperative pain control with less systemic opioid consumption. Objectives: The aim of this study was to describe the ultrasound (US)-guided transincisional quadratus lumborum block (TiQLB) as a new approach, and to compare the addition of dexmedetomidine to bupivacaine versus bupivacaine alone for TiQLB in combination with GA regarding postoperative analgesia and adverse effects in open renal surgery. Study Design: A prospective, randomized, double-blind, controlled trial. Setting: Ain Shams University Hospitals. Methods: Eighty patients who were scheduled for an elective open renal surgery, aged 20 to 65 years, of either gender, and American Society of Anesthesiologists physical status I to II were enrolled in the study. They were randomly allocated into 2 equal groups: group dexmedetomidine-bupivacaine (DB) (n = 40) in which patients received combined GA plus TiQLB with 30 mL bupivacaine 0.25% plus 1 μg/kg dexmedetomidine, and group bupivacaine (B) (n = 40) in which patients received combined GA plus TiQLB with 30 mL bupivacaine 0.25% only. The primary outcome was the total morphine consumption among both groups, whereas the secondary outcomes were the Visual Analog Scale (VAS) scores and the time to first analgesic requirement during the first 24 hours. Postoperative side effects, such as sedation, nausea, vomiting, shivering, pruritus, bradycardia, hypotension, and respiratory depression, were also recorded. Results: Patients in the DB group experienced lower total morphine consumption and lower VAS scores when compared with patients in the B group (P < 0.001). Time to first analgesic requirement was prolonged in patients in the DB group (18.6 ± 2.4 hours) in comparison to patients in the B group (7.3 ± 1.1 hours). Ten minutes after the block there was a significant reduction in mean blood pressure and heart rate in the DB group than in the B group. Regarding postoperative adverse effects, sedation scores were higher in the DB group than in the B group, postoperative nausea, vomiting, and shivering were significantly higher in the B group than in the DB group. Bradycardia was significantly more frequent among the DB group. Although nonsignificant, pruritus was more frequent in the B group than in the DB group. No cases of respiratory depression were reported in both groups. Limitations: The used technique US-guided TiQLB could be performed in open renal surgeries only. Conclusions: The new approach US-guided TiQLB was effective and easy to be performed. Adding dexmedetomidine to bupivacaine in TiQLB was associated with potent and prolonged postoperative analgesia with fewer postoperative adverse effects. Key words: Quadratus lumborum block, dexmedetomidine, open renal surgery, postoperative pain, bupivacaine

Dexmedetomidine as an Adjuvant in Peripheral Nerve Block

“…Alansary et al 121 performed QLB on 80 patients undergoing open kidney surgery. The experimental group received 30 mL of 0.25% bupivacaine + 1 μg/kg dexmedetomidine.…”

Transincisional quadratus lumborum block in robotic and laparoscopic renal and adrenal surgery: a novel approach

“…The QLB has emerged as an efficacious regional anaesthetic technique used to optimize analgesia in renal surgery. It is commonly administered by anaesthetists using an ultrasonography-guided approach, and only two papers to date have described a surgeon-assisted transincisional approach, both in open renal surgery [7,8]. We have, for the first time, described a modification of the QLB administered in a robot-assisted or laparoscopic renal or adrenal surgical setting.…”

“…The QL muscle is however directly visible and accessible to the operating surgeon, particularly via a retroperitoneal approach and we have found that delivery of a QLB by the operating surgeon under direct vision may be done quickly and easily. Alansary et al recently described a transincisional ultrasonography-guided QLB in open renal surgeries to positive effect in a randomized controlled trial [7], as did Suri et al in a case series [8].…”

“…Alansary et al. recently described a transincisional ultrasonography‐guided QLB in open renal surgeries to positive effect in a randomized controlled trial [7], as did Suri et al. in a case series [8].…”

Effects of Subcostal Anterior Quadratus Lumborum Block with and without Dexmedetomidine on Postoperative Rehabilitation in Patients Undergoing Laparoscopic Renal Surgery: A Prospective Double-Blinded Randomized Controlled Study

“…Our results was also similar to a study by Elsharkawy et al 22 indicating that SQLB provided the appropriate thoracic dermatome level needed for analgesia following open urological surgical procedures. What is more, Alansary et al 42 reported that a prolonged duration of initial analgesia in the QLB plus DEX group compared to the QLB group in patients undergoing open kidney surgery. El Sherif et al 24 revealed that from 2 to 8 h postoperatively, VAS scores at rest and during movement were significantly lower in the TAPB-DEX group compared with the TAPB group, results that are consistent with our study.…”