Efficacy of transmuscular quadratus lumborum block in the multimodal regimen for postoperative analgesia after total laparoscopic hysterectomy: A prospective randomised double-blinded study

Jadon, Ashok; Ahmad, Asif; Sahoo, Rajendra Kumar; Sinha, Neelam; Chakraborty, Swastika; Bakshi, Apoorva

doi:10.4103/ija.ija_1258_20

Cited by 14 publications

(21 citation statements)

References 27 publications

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“…For total laparoscopic hysterectomies, studies show varying results 9 10. The study by Hansen et al 9 showed no reduction in postoperative opioid consumption during the first 12 hours after surgery with a preoperative bilateral anterior QL block.…”

Section: Discussionmentioning

confidence: 99%

“…The postoperative blocks are often considered more difficult because of impaired visualization due to hematomas, residual gas, etc. However, it is worth noticing that two studies with anterior QL blocks administered postsurgery but prior to emergence showed a significant postoperative opioid reduction compared with placebo 10 11…”

Section: Discussionmentioning

confidence: 99%

“…The effectiveness in reducing opioid consumption when administering the ultrasound-guided anterior QL block is evident in three randomized controlled studies 6–8. However, recent results vary when the effect is investigated for laparoscopic surgery; that is, some studies show a reduced opioid consumption and others do not 8–14…”

Section: Introductionmentioning

confidence: 99%

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Anterior quadratus lumborum block does not reduce postoperative opioid consumption following laparoscopic hemicolectomy: a randomized, double-blind, controlled trial in an ERAS setting

Tanggaard

Hasselager

Hølmich

et al. 2022

Reg Anesth Pain Med

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Background and aimsAn opioid-sparing postoperative analgesic regimen following laparoscopic hemicolectomy is optimal to promote minimal postoperative pain, early mobilization, and improved quality of recovery. Various regional anesthesia techniques have been tested to improve postoperative pain management after laparoscopic hemicolectomy. In this study, we aimed to assess the effect of administering a preoperative bilateral ultrasound-guided anterior quadratus lumborum nerve block on postoperative opioid consumption after laparoscopic colon cancer surgery.MethodsIn this randomized, controlled, double-blinded trial, 69 patients undergoing laparoscopic hemicolectomy due to colon cancer were randomized to receive an anterior quadratus lumborum block with ropivacaine 0.375% 30 mL on each side or isotonic saline (placebo). The primary outcome measure was total opioid consumption during the first 24 hours postsurgery. The secondary outcome measures were pain scores, accumulated opioid consumption in 6-hour intervals, nausea and vomiting, ability of postoperative ambulation, time to first opioid, orthostatic hypotension or intolerance, postoperative Quality of Recovery-15 scores, surgical complications, length of hospital stay, and adverse events.ResultsThe total opioid consumption in the first 24 hours postsurgery was not significantly reduced in the ropivacaine group compared with the saline group (mean 129 mg (SD 88.4) vs mean 127.2 mg (SD 89.9), p=0.93). In addition, no secondary outcome measures showed any statistically significant intergroup differences.ConclusionThe administration of a preoperative bilateral anterior quadratus lumborum nerve block as part of a multimodal analgesic regimen for laparoscopic hemicolectomy did not significantly reduce opioid consumption 24 hours postsurgery.Trial registration numberNCT03570541.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Anterior quadratus lumborum block does not reduce postoperative opioid consumption following laparoscopic hemicolectomy: a randomized, double-blind, controlled trial in an ERAS setting

Tanggaard

Hasselager

Hølmich

et al. 2022

Reg Anesth Pain Med

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“…The TAP block added to combination of paracetamol and NSAID does not improve pain control compared to effects provided by combination of paracetamol and NSAID alone. 31,32 QLB significantly reduces perioperative opioid use after CD, 8,[22][23][24][26][27][28]33 laparoscopic hysterectomy (LH), [34][35][36] and total abdominal hysterectomy (TAH), 37,38 and consequently a frequency of postoperative nausea and vomiting. 35 QLB as a part of multimodal pain management, given in combination with paracetamol and NSAID, also prolongs time to first request for breakthrough pain following CD, 8,[22][23][24]27,33 LH, 34,35,39 and TAH.…”

Section: Discussionmentioning

confidence: 99%

“…QLB significantly reduces perioperative opioid use after CD, ( 8 , 22 - 24 , 26 - 28 , 33 ) laparoscopic hysterectomy (LH), ( 34 - 36 )and total abdominal hysterectomy (TAH), ( 37 , 38 ) and consequently a frequency of postoperative nausea and vomiting. ( 35 ) QLB as a part of multimodal pain management, given in combination with paracetamol and NSAID, also prolongs time to first request for breakthrough pain following CD, ( 8 , 22 - 24 , 27 , 33 ) LH, ( 34 , 35 , 39 ) and TAH.…”

Section: Discussionmentioning

confidence: 99%

Interfascial Plane Blocks in Obstetric and Gynecologic Surgery

Pejčić¹

2022

ACC

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Introduction: Interfascial plane blocks (IPB) are truncal blocks with local anesthetic injected into space between two muscle layers. IPBs are easy to learn, simple to perform, provide satisfactory analgesia up to 24 hours, having a minimal risk of complications.Methods: We present a retrospective analysis of the patients who had IPB as a part of postoperative pain management plan following either CD or hysterectomy in Leskovac General Hospital, Serbia during the period April 2017 -February 2022.Results: We had 131 patients who had IPB perioperatively. Bilateral QLB type 1 was performed in 53 patients after CD and in 68 patients after hysterectomy. Bilateral ESPB T10-11 was done following one CD case and in 9 patients before hysterectomy. Patients had both acetaminophen and nonsteroidal anti-inflammatory drug for postoperative pain control. Decreased usage of fentanyl and sevoflurane was noticed in the cases where IPB was performed preoperatively. Almost all patients had well-controlled pain, and were very satisfied with pain score of 0-4/10 at numeric rating scale during 24 hours after surgery, with no opioid use. There were no complications regarding block performance.Conclusion: QLB and ESPB have great potential to improve and facilitate postoperative pain management in obstetric and gynecologic surgery.

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Effects of Erector Spinae Plane Block and Transmuscular Quadratus Lumborum Block on Postoperative Opioid Consumption in Total Laparoscopic Hysterectomy: A Randomized Controlled Clinical Trial

Jiang

Wang

et al. 2023

Pain Ther

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Introduction Total laparoscopic hysterectomy (TLH) is a common surgical procedure that is frequently associated with substantial postoperative pain. As part of multimodal analgesia, the erector spinae plane block (ESPB) and transmuscular quadratus lumborum block (TQLB) have been demonstrated to be effective. This study aimed to evaluate whether ESPB and TQLB reduce postoperative pain and opioid consumption after TLH. Methods A total of 90 female patients undergoing TLH were randomized to receive either ESPB, TQLB, or no intervention before general anesthesia. All patients received a patient-controlled sufentanil analgesia postoperatively. Postoperative pain and sufentanil consumption were evaluated. The primary outcome was cumulative sufentanil consumption at 12 h postoperatively. Results The cumulative sufentanil consumption at 12 h postoperatively was significantly lower in Group ESPB than in Group CON after Bonferroni correction (median [interquartile range], 0 [0, 4] μg vs. 6 [0, 10] μg; median difference = − 3; 95% confidence interval, − 6–0; P = 0.010). There were no significant differences between Group TQLB and CON (0 [0, 4] μg vs. 6 [0, 10] μg; P = 0.098) or between the two block groups ( P = 1.000). When compared with Group CON, ESPB and TQLB persistently reduced pain scores until 6 and 4 h after surgery, respectively ( P < 0.05). However, no significant differences were found in pain scores between the two block groups. Conclusions ESPB and TQLB improved the quality of multimodal analgesia for TLH. ESPB may be more favorable due to the prolonged period of analgesia and decreased opioid consumption after TLH. Clinical Trial Registration Chinese Clinical Trial Registry: ChiCTR2100048165, Registry URL: http://www.chictr.org.cn/showproj.aspx?proj=129578 . Date of registration: July 4, 2021. The patient enrollment began on July 12, 2021. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-023-00505-1.

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Efficacy of transmuscular quadratus lumborum block in the multimodal regimen for postoperative analgesia after total laparoscopic hysterectomy: A prospective randomised double-blinded study

Cited by 14 publications

References 27 publications

Anterior quadratus lumborum block does not reduce postoperative opioid consumption following laparoscopic hemicolectomy: a randomized, double-blind, controlled trial in an ERAS setting

Anterior quadratus lumborum block does not reduce postoperative opioid consumption following laparoscopic hemicolectomy: a randomized, double-blind, controlled trial in an ERAS setting

Interfascial Plane Blocks in Obstetric and Gynecologic Surgery

Effects of Erector Spinae Plane Block and Transmuscular Quadratus Lumborum Block on Postoperative Opioid Consumption in Total Laparoscopic Hysterectomy: A Randomized Controlled Clinical Trial

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