Analgesic efficacy of ultrasound-guided transversus abdominis plane block and lateral approach quadratus lumborum block after laparoscopic appendectomy: A randomized controlled trial

Gokhan Sertcakacilar, Gunes Ozlem Yildiz, Gokhan Sertcakacilar, Gunes Ozlem Yildiz

Abstract

Background: Laparoscopic appendectomy is the most performed emergency surgical technique worldwide. Transversus abdominis plane (TAP) blocks, which are easier to achieve with ultrasound, are frequently used in multimodal analgesia techniques for this surgery. Quadratus lumborum (QL) block has become a standard block, first used in gynecological and other abdominal surgeries. This study was planned to compare the analgesic efficacy of ultrasound-guided QL and TAP blocks for postoperative analgesia after laparoscopic appendectomy.

Materials and methods: A total of 136 patients aged 18-65 years who underwent laparoscopic appendectomy were randomized and divided into two groups. A volume of 40 ml of local anesthetic containing 0.375% bupivacaine was administered for block applications in group TAP (n = 68) and group QL (n = 68). In addition, a patient-controlled analgesia device was used to administer bolus tramadol hydrochloride at a dose of 10 mg to relieve pain in the postoperative period. Postoperative opioid consumption of patients was recorded as the primary outcome and pain scores (1, 6, 12, 18, 24 h) as the secondary outcome.

Results: Both groups were statistically similar in demographic and surgical data. There were no statistically significant differences between the groups over 24 h in terms of intraoperative remifentanil consumption (p = 0.584), postoperative cumulative opioid consumption (p = 0.807), and pain scores. No complications were observed in either group related to the block.

Conclusion: Ultrasound-guided lateral approach QL block may provide adequate analgesia efficacy in patients undergoing laparoscopic appendectomy, like TAP block, and may be included in multimodal analgesia in pain control.

Keywords: Laparoscopic appendectomy; Postoperative pain; Quadratus lumborum block; Transversus abdominis plane block.

Conflict of interest statement

The authors declare that they have no financial or personal relationship with any (biased) person or organization that could improperly influence their work.

© 2022 The Authors.

Figures

Fig. 1
Fig. 1
(A) Location of the transducer with the lateral QL block; (B) An ultrasound image obtained immediately after injection of local anesthetics. EO, external oblique; IO, internal oblique; TA, transversus abdominis; QL, quadratus lumborum; LA, local anesthetics.
Fig. 2
Fig. 2
(A) Location of the transducer with the TAP block; (B) An ultrasound image obtained during injection of local anesthetics. EO, external oblique; IO, internal oblique; TA, transversus abdominis; LA, local anesthetics.
Fig. 3
Fig. 3
Flow chart of the study. QL, quadratus lumborum; TAP, transversus abdominis plane.

References

    1. Jawaid M., Raza S.M., Alam S.N., Manzar S. On-call emergency workload of a general surgical team. J. Emergencies, Trauma, Shock. 2009;2(1):15–18. doi: 10.4103/0974-2700.44677.
    1. Li X., Zhang J., Sang L., Zhang W., Chu Z., Li X., et al. Laparoscopic versus conventional appendectomy-a meta-analysis of randomized controlled trials. BMC Gastroenterol. 2010;10:129.
    1. Pedersen A.G., Petersen O.B., Wara P., Rønning H., Qvist N., Lauberg S. Randomized clinical trial of laparoscopic versus open appendicectomy. Br. J. Surg. 2001;88(2):200–205. doi: 10.1046/j.1365-2168.2001.01652.x.
    1. Sabbagh C., Brehant O., Dupont H., Browet F., Pequignot A., Regimbeau J.M. The feasibility of short-stay laparoscopic appendectomy for acute appendicitis:a prospective cohort study. Surg. Endosc. 2012;26(9):2630–2638. doi: 10.1007/s00464-012-2244-1.
    1. Ra Y.S., Kim C.H., Lee G.Y., Han J.I. The analgesic effect of the ultrasound-guided transverse abdominis plane block after laparoscopic cholecystectomy. Korean J Anesthesiol. 2010;58:362–368.
    1. McDonnell J.G., O'Donnell B., Curley G., Heffernan A., Power C., Laffey J.G. The analgesic efficacy of transversus abdominis plane block after abdominal surgery:a prospective randomized controlled trial. Anesth. Analg. 2007;104(1):193–197. doi: 10.1213/01.ane.0000250223.49963.0f.
    1. Karaman T., Ozsoy A.Z., Karaman S., Dogru S., Tapar H., Sahin A., et al. The effects of transversus abdominis plane block on analgesic and anesthetic consumption during total abdominal hysterectomy: a randomized controlled study. Rev. Bras. Anestesiol. 2018;68(3):285–291. doi: 10.1016/j.bjan.2017.12.005.
    1. Rafi A.N. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001;56(10):1024–1026. doi: 10.1046/j.1365-2044.2001.02279-40.x.
    1. Walter E.J., Smith P., Albertyn R., Uncles D.R. Ultrasound imaging for transversus abdominis blocks. Anaesthesia. 2008;63(2):211. doi: 10.1111/j.1365-2044.2007.05424.x.
    1. Tupper-Carey D.A., Fathil S.M., Tan Y.K., Kan Y.M., Cheong C.Y., Siddiqui F.J., et al. A randomised controlled trial investigating the analgesic efficacy of transversus abdominis plane block for adult laparoscopic appendicectomy. Singap. Med. J. 2017;58(8):481–487. doi: 10.11622/smedj.2016068.
    1. Baeriswyl M., Kirkham K.R., Kern C., Albrecht E. The analgesic efficacy of ultrasound-guided transversus abdominis plane block in adult patients: a meta-analysis. Anesth. Analg. 2015;121(6):1640–1654.
    1. Blanco R. 271. Tap block under ultrasound guidance: the description of a “no pops” technique. Reg. Anesth. Pain Med. 2007;32:130.
    1. Aygun H., Kavrut Ozturk N., Pamukcu A.S., Inal A., Kiziloglu I., Thomas D.T., et al. Comparison of ultrasound guided Erector Spinae Plane Block and quadratus lumborum block for postoperative analgesia in laparoscopic cholecystectomy patients; a prospective randomized study. J. Clin. Anesth. 2020;62 doi: 10.1016/j.jclinane.2019.109696.
    1. Deng W., Long X., Li M., Li C., Guo L., Xu G., et al. Quadratus lumborum block versus transversus abdominis plane block for postoperative pain management after laparoscopic colorectal surgery: a randomized controlled trial. Medicine (Baltim.) 2019;98(52) doi: 10.1097/MD.0000000000018448.
    1. İpek C.B., Kara D., Yılmaz S., Yeşiltaş S., Esen A., Dooply S., et al. Comparison of ultrasound-guided transversus abdominis plane block, quadratus lumborum block, and caudal epidural block for perioperative analgesia in pediatric lower abdominal surgery. Turk. J. Med. Sci. 2019;49(5):1395–1402. doi: 10.3906/sag-1812-59.
    1. Ueshima H., Otake H., Lin J.A. Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. BioMed Res. Int. 2017;2017 doi: 10.1155/2017/2752876.
    1. LauJWY, Rosin D., Agha R. The CONSORT (CONsolidated standards of reporting trials) 2010 guideline. Int. J. Surg. 2021;93:2900565–2900566. Avaialble online: .
    1. B. Siam, A. Al-Kurd, N. Simanovsky, H. Awesat, Y. Cohn, B. Helou, et al. Comparison of appendectomy outcomes between senior general surgeons and general surgery residents, JAMA Surg 152 (7) 2017 679-685. doi:10.1001/jamasurg.2017.0578.
    1. Pedersen A.G., Petersen O.B., Wara P., Rønning H., Qvist N., Laurberg S. Randomized clinical trial of laparoscopic versus open appendicectomy. Br. J. Surg. 2001;88(2):200–205. doi: 10.1046/j.1365-2168.2001.01652.x.
    1. Sabbagh C., Brehant O., Dupont H., Browet F., Pequignot A., Regimbeau J.M. The feasibility of short-stay laparoscopic appendectomy for acute appendicitis: a prospective cohort study. Surg. Endosc. 2012;26(9):2630–2638. doi: 10.1007/s00464-012-2244-1.
    1. Kim A.J., Yong R.J., Urman R.D. The role of transversus abdominis plane blocks in enhanced recovery after surgery pathways for open and laparoscopic colorectal surgery. J. Laparoendosc. Adv. Surg. Tech. 2017;27(9):909–914. doi: 10.1089/lap.2017.0337.
    1. Akerman M., Pejčić N., Veličković I.A. Review of the quadratus lumborum block and ERAS. Front. Med. 2018;5:44. doi: 10.3389/fmed.2018.00044.
    1. Jalali S.M., Bahri M.H., Yazd S.M.M., Karoobi M., Shababi N. Efficacy of laparoscopic transversus abdominis plane block on postoperative pain management and surgery side effects in laparoscopic bariatric surgeries. Langenbeck's Arch. Surg. 2022;407(2):549–557. doi: 10.1007/s00423-021-02400-9.
    1. Baeriswyl M., Kirkham K.R., Kern C., Albrecht E. The analgesic efficacy of ultrasound-guided transversus abdominis plane block in adult patients: a meta-analysis. Anesth. Analg. 2015;121(6):1640–1654. doi: 10.1213/ANE.0000000000000967.
    1. Tsai H.C., Yoshida T., Chuang T.Y., Yang S.F., Chang C.C., Yao H.Y., et al. Transversus abdominis plane block: an updated review of anatomy and techniques. BioMed Res. Int. 2017;2017 doi: 10.1155/2017/8284363.
    1. Blanco R., Ansari T., Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: a randomised controlled trial. Eur. J. Anaesthesiol. 2015;32(11):812–818. doi: 10.1097/EJA.0000000000000299.
    1. Lai R., Luo Q., Lai J., Lu X., Xu M. Ultrasound-guided quadratus lumborum block for perioperative analgesia in robot-assisted partial nephrectomy: a randomized controlled trial. Trials. 2021;22(1):840. doi: 10.1186/s13063-021-05815-3.
    1. Kim S.H., Kim H.J., Kim N., Lee B., Song J., Choi Y.S. Effectiveness of quadratus lumborum block for postoperative pain: a systematic review and meta-analysis. Minerva Anestesiol. 2020;86(5):554–564. doi: 10.23736/S0375-9393.20.13975-0.
    1. Carline L., McLeod G.A., Lamb C. A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks. Br. J. Anaesth. 2016;117(3):387–394. doi: 10.1093/bja/aew224.
    1. Tamura T., Kitamura K., Yokota S., Ito S., Shibata Y., Nishiwaki K. Spread of quadratus lumborum block to the paravertebral space via intramuscular injection: a volunteer study. Reg. Anesth. Pain Med. 2018;43(4):372–377. doi: 10.1097/AAP.0000000000000735.
    1. Murouchi T., Iwasaki S., Yamakage M. Quadratus lumborum block: analgesic effects and chronological ropivacaine concentrations after laparoscopic surgery. Reg. Anesth. Pain Med. 2016;41(2):146–150. doi: 10.1097/AAP.0000000000000349.
    1. Huang D., Song L., Li Y., Xu Z., Li X., Li C. Posteromedial quadratus lumborum block versus transversus abdominal plane block for postoperative analgesia following laparoscopic colorectal surgery: a randomized controlled trial. J. Clin. Anesth. 2020;62 doi: 10.1016/j.jclinane.2020.109716.
    1. Liu X., Song T., Chen X., Zhang J., Shan C., Chang L., et al. Quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia in patients undergoing abdominal surgeries: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol. 2020;20(1):53. doi: 10.1186/s12871-020-00967-2.
    1. Blanco R., Ansari T., Riad W., Shetty N. Quadratus lumborum block versus transversus abdominis plane block for postoperative pain after cesarean delivery: a randomized controlled trial. Reg. Anesth. Pain Med. 2016;41(6):757–762. doi: 10.1097/AAP.0000000000000495.
    1. Baytar Ç., Yılmaz C., Karasu D., Topal S. Comparison of ultrasound-guided subcostal transversus abdominis plane block and quadratus lumborum block in laparoscopic cholecystectomy: a prospective, randomized, controlled clinical study. Pain Res. Manag. 2019;2019 doi: 10.1155/2019/2815301.
    1. Tamura T., Yokota S., Ito S., Shibata Y., Nishiwaki K. Local anesthetic spread into the paravertebral space with two types of quadratus lumborum blocks: a crossover volunteer study. J. Anesth. 2019;33(1):26–32. doi: 10.1007/s00540-018-2578-5.
    1. Ökmen K., Metin Ökmen B., Sayan E. Ultrasound-guided lateral versus posterior Quadratus Lumborum Block for postoperative pain after laparoscopic cholecystectomy: a randomized controlled trial. Turk J Surg. 2019;35(1):23–29. doi: 10.5578/turkjsurg.4161.
    1. Xue Q., Chu Z., Zhu J., Zhang X., Chen H., Liu W., et al. Analgesic efficacy of transverse abdominis plane block and quadratus lumborum block in laparoscopic sleeve gastrectomy: a randomized double-blinded clinical trial. Pain Ther. 2022;10 doi: 10.1007/s40122-022-00373-1. 1007. s40122-022-00373-1.
    1. Tanggaard K., Jensen K., Lenz K., Vazin M., Binzer J., Lindberg-Larsen V.O., et al. A randomised controlled trial of bilateral dual transversus abdominis plane blockade for laparoscopic appendicectomy. Anaesthesia. 2015;70(12):1395–1400. doi: 10.1111/anae.13234.
    1. Tran D.Q., Bravo D., Leurcharusmee P., Neal J.M. Transversus abdominis plane block: a narrative review. Anesthesiology. 2019;131(5):1166–1190. doi: 10.1097/ALN.0000000000002842.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe