Randomized controlled trial of a quadratus lumborum block with liposomal bupivacaine for postoperative analgesia in laparoscopic donor nephrectomy

Abstract

Perioperative pain management is an important consideration in early recovery and patient satisfaction following laparoscopic donor nephrectomy. Transmuscular quadratus lumborum block has been described to reduce pain and opioid usage following several abdominal surgeries. In this prospective single-blind randomized controlled trial, we compared 52 patients who adhered to our institutional donor nephrectomy Early Recovery After Surgery pathway, which includes a laparoscopic-guided transversus abdominus plane block, to 40 patients who additionally received a transmuscular quadratus lumborum block with liposomal bupivacaine. Compared to control patients, those who received the block spent longer in the operating room prior to the surgical start (65.4 vs. 51.6 min, P < .001). Both groups had similar total hospital length of stay (33.3 h vs. 34.4 h, P = .61). Pain scores from postoperative days 0-30, number of patients requiring opioids, postoperative nausea, and pain management satisfaction were similar between both groups. Patients who received the block consumed less opioid on postoperative day 1 compared to controls (P = .006). No complications were attributable to the block. The quadratus lumborum block provides a safe pain management adjunct for some patients, and may reduce opioid use in the early postoperative period when combined with our standard institutional protocol for kidney donors.

A systematic review of opioid use and multimodal strategies in solid organ transplant recipients and living donors

“…Seven of 11 (64%) evaluations assessing PRPS demonstrated significantly lower pain scores when using these multimodal strategies 16,55–57,62,63,65 . Additionally, MME consumption was lower in nine out of 12 studies (75%) within 48 h of surgery 15,16,55,58,61,63–65,67 . LOS was significantly shorter in seven out of 11 (64%) studies 15,16,56,58–60,63 .…”

“…Nine studies evaluated the impact of intraoperative and/or postoperative ketorolac therapy 15,53–60 . Intraoperative and postoperative multimodal analgesic strategies including pregabalin/gabapentin, APAP, continuous infusion of anesthetics, TAP/ QL blocks, liposomal bupivacaine, avoidance of PCA, and auricular field nerve stimulation were used in 14 studies 15,16,53,55–58,61–67 . Seven of 11 (64%) evaluations assessing PRPS demonstrated significantly lower pain scores when using these multimodal strategies 16,55–57,62,63,65 .…”

“…16,[55][56][57]62,63,65 Additionally, MME consumption was lower in nine out of 12 studies (75%) within 48 h of surgery. 15,16,55,58,61,[63][64][65]67 LOS was significantly shorter in seven out of 11 (64%) studies. 15,16,56,[58][59][60]63 No differences in safety outcomes were noted with regards to drowsiness, sedation, itching, or return to bowel function.…”

“…15,[53][54][55][56][57][58][59][60] Intraoperative and postoperative multimodal analgesic strategies including pregabalin/gabapentin, APAP, continuous infusion of anesthetics, TAP/ QL blocks, liposomal bupivacaine, avoidance of PCA, and auricular field nerve stimulation were used in 14 studies. 15,16,53,[55][56][57][58][61][62][63][64][65][66][67] Seven of 11 (64%) evaluations assessing PRPS demonstrated significantly lower pain scores when using these multimodal strategies. 16,[55][56][57]62,63,65 Additionally, MME consumption was lower in nine out of 12 studies (75%) within 48 h of surgery.…”

Epidural versus intravenous analgesia for pain control in kidney donors, a retrospective cohort study. Is there a kinship relationship?

“…Erector spinae block have recently been demonstrated to provide good analgesia and reduce opioid consumption in LDN. 21 Gritsch et al 22 have used quadratus lumborum block with liposomal bupivacaine for the pain management in laparoscopic LDN patients. The block was demonstrated to be a good adjunct for pain management in some patients with reduced opioid consumption in some patients.…”