Transmuscular quadratus lumborum block for percutaneous nephrolithotomy reduces opioid consumption and speeds ambulation and discharge from hospital: a single centre randomised controlled trial

Abstract

Background: Percutaneous nephrolithotomy (PNL) is associated with severe postoperative pain. The current study aimed to investigate the analgesic efficacy of transmuscular quadratus lumborum (TQL) block for patients undergoing PNL surgery. Methods: Sixty patients were enrolled in this single centre study. The multimodal analgesic regime consisted of oral paracetamol 1 g and i.v. dexamethasone 4 mg before surgery and i.v. sufentanil 0.25 mg kg À1 30 min before emergence. After operation, patients received paracetamol 1 g regularly at 6 h intervals. Subjects were allocated to receive a preoperative TQL block with either ropivacaine 0.75%, 30 ml (intervention) or saline 30 ml (control). Primary outcome was oral morphine equivalent (OME) consumption 0e6 h after surgery. Secondary outcomes were OME consumption up to 24 h, pain scores, time to first opioid, time to first ambulation, and hospital length of stay. Results were reported as mean (standard deviation) or median (inter-quartile range). Results: Morphine consumption was lower in the intervention group at 6 h after surgery (7.2 [8.7] vs 90.6 [69.9] mg OME, P<0.001) and at 24 h (54.0 [36.7] vs 126.2 [85.5] mg OME, P<0.001). Time to first opioid use was prolonged in the intervention group (678 [285e1020] vs 36 [19e55] min, P<0.0001). Both the time to ambulation (302 [238e475] vs 595 [345e925] min, P<0.004) and length of stay (2.0 [0.8] vs 3.0 [1.2] days, P 0.001) were shorter in the intervention group. Conclusions: This is the first blinded, RCT that confirms that unilateral TQL block reduces postoperative opioid consumption and hospital length of stay. Further study is required for confirmation and dose optimisation. Clinical trial registration: NCT02818140.

Retrospective study of quadratus lumborum block for postoperative analgesia in patients undergoing percutaneous nephrolithotomy

“…Their results implicated that QLB-TM is superior to the posterior approach in decreasing the postoperative pain intensity. In the recent two prospective clinical studies conducted by Dam and KılıçE et al respectively [10,19], the potency of transmuscular approach of QLB in postoperative pain relief after PCNL procedure was assessed. As a result, QLB-TM rendered the beneficial effect in alleviating the pain of patients during activity after surgery, shortened the time to ambulation, LOS, and promoting the recovery of patients.…”

Perioperative Analgesic Effects of Preemptive Ultrasound-Guided Subcostal Transversus Abdominis Plane Block for Percutaneous Nephrolithotomy: A Prospective, Randomized Trial

“…Randomized studies show that QLB reduces VAS and opioid consumption compared to intravenous analgesic regimens. [27][28][29] These results show that regional blocks applied before or after the surgery are effective and are worth to be considered for multimodal analgesic regimes.…”

Analgesic sparing effect of dexamethasone with levobupivacaine in quadratus lumborum block in patients undergoing unilateral inguinal hernia repair: A prospective randomised controlled trial

“…[ 9 ] Unilateral transmuscular QLB (QLB-3) showed an effective postoperative analgesia method in children undergoing pyeloplasty and percutaneous nephrolithotomy (PNL) in adults. [ 5 8 ] QLB-3 reduces opioid consumption, speeds ambulation and allows the earlier discharge of the patients from the hospital in PNL surgeries. [ 8 ] The combination of lumbar erector spinae plane block (ESPB) and QLB was used for the anaesthesia management in high-risk patients undergoing hemiarthroplasty.…”

“…[ 4 ] The QLB has been shown to provide effective postoperative analgesia in abdominal surgery, laparoscopic surgery and caeserean deliveries. [ 5 6 7 8 9 10 11 12 ] Several approaches have been described for the QLB. Lateral QLB (QLB-1) where local anaesthetic (LA) is injected at the anterolateral border of the QL muscle, posterior QLB (QLB-2) where LA is injected at the junction of QL muscle with the transversalis fascia and transmuscular QLB (QLB-3), where the needle is advanced through the QL muscle, penetrating the ventral proper fascia of the QL muscle and LA is finally injected between the QL muscle and psoas major (PM) muscle.…”