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

Abstract

PurposeWe hypothesized that posterior quadratus lumborum block would reduce postoperative opioid consumption and improve the quality of recovery in patients undergoing sutureless laparoscopic partial nephrectomy.Materials and methodsThe study included 60 patients, ages 18−65 with American Society of Anesthesiologists scores of I-II scheduled for elective sutureless laparoscopic partial nephrectomy. Before general anesthesia, 60 participating patients were randomly allocated to receive a 30-ml injection posterior to the quadratus lumborum muscle with either 0.375% ropivacaine (n = 30) or normal saline (n = 30). The primary outcomes included cumulative opioid consumption within 12 h postoperatively and quality of postoperative recovery at 48 h. Secondary outcomes included the Numerical Rating Scale (NRS), opioid consumption by period, first time to press the analgesic pump, number of patients needing rescue analgesia, blood glucose and cortisol concentrations, early postoperative recovery indicators, and adverse events.ResultsThere were 48 patients included in the final analysis. The intervention group had lower cumulative consumption of sufentanil within 12 h postoperatively and higher quality of postoperative recovery scores at 48 h postoperatively compared with the control group (p < 0.001). The NRS at resting and movement of the intervention group was lower at 0 h, 6 h, and 12 h after surgery than in the control group (p < 0.05). At prespecified intervals (0 to 2 h, 2 to 6 h, 6 to 12 h, 12 to 24 h, and 24 to 48 h) after surgery, the intervention group had lower consumption of sufentanil compared with the control group (p < 0.05). The intervention group took longer to press the analgesic pump for the first time within 48 h after surgery compared with the control group (p < 0.001). The postoperative blood glucose and cortisol concentrations in the intervention group were lower than in the control group (p < 0.05). The times to first excretion, ambulation, and discharge were shorter in the intervention group compared with the control group (p < 0.05). There was no significant difference in adverse events between the two groups.ConclusionsOur trial demonstrated that patients who received posterior quadratus lumborum block had significantly lower opioid consumption within 12 h postoperatively and had a better quality of recovery at 48 h postoperatively. Therefore, we recommend posterior quadratus lumborum block as an option for postoperative analgesia in patients undergoing sutureless laparoscopic partial nephrectomy.Trial Registrationhttp://www.chictr.org.cn, identifier ChiCTR2100053439.

Comparison of ultrasound-guided erector spinal muscle plane block and quadratus block for laparoscopic renal cancer resection:A single-center,double-blind, randomized controlled trial

“…Li et al [19] used QLB-I and QLB-II after LN, both using 0.4% ropivacaine 30ml, the study results showed that the two blocks did not reduce opioid consumption, but improved analgesia within 24 hours after surgery. Zhu et al [20] performed QLB-II before LN and injected 30ml of 0.375% ropivacaine after reaching the block site. The study showed that the cumulative consumption of sufentanil within 12 hours after surgery was lower in the intervention group, and the quality of recovery was higher at 48 hours after surgery.…”

“…Zhu et al [20] performed QLB-II before LN and injected 30ml of 0.375% ropivacaine after reaching the block site. The study showed that the cumulative consumption of sufentanil within 12 hours after surgery was lower in the intervention group, and the quality of recovery was higher at 48 hours after surgery.…”

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

“…function and the mobilization time after surgery were significantly earlier in SQLB group than the control group for laparoscopic nephrectomy in a randomized controlled trial. Similarly, in a triple-blind, randomized, controlled study for laparoscopic partial nephrectomy, by Zhu et al 44 showed the time to the patient's first excretion, ambulation, and drainage tube removal were shorter in the QLB group compared with the control group. Likewise, other studies have reported that compared with GA, QLB for patients undergoing abdominal surgery shortened the first time of getting up, flatus and taking semi-liquid diet, findings consistent with our study.…”