Ultrasound-guided quadratus lumborum block for postoperative pain control in patients undergoing unilateral inguinal hernia repair, a comparative study between two approaches.

Abstract

Background : early postoperative ambulation and reduction of hospital stay necessitate efficient postoperative analgesia. Quadrates Lumborum Block (QLB) has been described to provide adequate postoperative analgesia after abdominal surgery. This randomized comparative trial was designed to compare the duration of analgesia provided by two different QLB approaches; the posterior QLB (QLB-2) and transmuscular QLB (QLB-3) in patients undergoing surgical repair of unilateral inguinal hernia. Methods: Forty patients, aged from 18-50 years, ASA physical status I or II, scheduled for unilateral inguinal hernia repair were enrolled. At the end of the surgical procedure and before recovery from general anesthesia, Patients were randomly assigned into two groups to receive either posterior QLB (Group QLB-2) or transmuscular QLB (Group QLB-3) using 20 ml 0.25% bupivacaine. Duration of analgesia, postoperative VAS and postoperative opioid consumption were recorded. Results : duration of block was significantly longer in QLB-3 group when compared to QLB-2 group (20.1 + 6.2 hours versus 12.0 + 4.8 respectively) with P value of < 0.001. A statistically significant lower VAS score was recorded in QLB-3 group immediately and 12 hrs postoperative. QLB-3 group showed a statistically significant delayed time of first analgesic request and less postoperative morphine consumption with P value of < 0.001 and 0.001 respectively. Conclusions : Ultrasound guided postsurgical transmuscular approach of QLB (QLB-3) using 20 ml 0.25% bupivacaine produces more postoperative analgesic effect and less postoperative opioid consumption when compared to posterior QLB approach (QLB-2) in patients underwent unilateral inguinal hernia repair under general anesthesia. Trial Registration : ClinicalTrials.gov identifier: NCT03526731- on 16 May 2018

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

“…We also found that posterior QLB significantly prolonged the time to the first opioid requirement. The median time to the first compression of the analgesic pump in the intervention group was significantly longer than in the control group, about 18 h. In the trials of Li et al (12) and Ahmed et al (22), the median time to the first compression of the analgesic pump was 13.5 h and 12 h, respectively. This difference may be related to multimodal analgesia's type or the dose of other analgesics.…”

Efficacy of a TAP block versus an anterior QLB for laparoscopic inguinal hernia repair: A randomised controlled trial

“…Previous studies have shown both the TAP block and the anterior QLB to be effective in lowering postoperative pain score and opioid consumption in inguinal repair 4,5 . Ahmed et al 5 found that the anterior QLB significantly lowered postoperative pain scores immediately after arrival in the PACU and after 12 h. A meta‐analysis looking at the duration of a lateral and a posterior TAP showed a reduction of opioid consumption, rest and dynamic pain up to 48 h 16 …”

“…Both the TAP block and the anterior Quadratus lumborum (QLB) have been shown to reduce postoperative pain and opioid consumption after laparoscopic inguinal hernia repair 4–6 . The TAP block can be performed using several approaches: subcostal, lateral and posterior 6 .…”

To evaluate the effect of quadratus lumborum block on the tramadol sparing effect in patients undergoing open inguinal hernia surgery: A randomised controlled trial

“…The authors reported a longer duration of block in transmuscular QL block group as compared to posterior QL block group (20.1 ± 6.2 versus 12.0 ± 4.8 h, respectively) with a P value of <0.001. Although the authors concluded that total morphine consumption was reduced in the posterior QL group (1.9 ± 0.6 mg versus 1.1 ± 0.9 mg) than in the transmuscular QL group over 24 h,[ 22 ] it does not satisfy aclinically meaningful difference. The present study as compared to that of Ahmed et al .…”