Analgesic Effect of Ultrasound-Guided Preoperative Unilateral Lateral Quadratus Lumborum Block for Laparoscopic Nephrectomy: A Randomized, Double-Blinded, Controlled Trial

Kyung-Hwa Kwak, Seung Ik Baek, Jay Kyoung Kim, Tae-Hwan Kim, Jinseok Yeo, Kyung-Hwa Kwak, Seung Ik Baek, Jay Kyoung Kim, Tae-Hwan Kim, Jinseok Yeo

Abstract

Purpose: The quadratus lumborum block (QLB) is a relatively new regional analgesic technique that could provide analgesia to the abdominal wall and reduce postoperative opioid consumption. We investigated the opioid-sparing effect of a unilateral lateral QLB in laparoscopic nephrectomy.

Patients and methods: A total of 60 patients undergoing laparoscopic nephrectomy were included in the study. Patients were randomized into two groups as QLB and control group. QLB group received QLB with 25mL 0.25% ropivacaine, and the control group received 25mL 0.9% saline at anterolateral border of quadratus lumborum muscle preoperatively. Opioid consumption and the pain intensity at rest and on movement were measured at 2nd, 6th, 24th, and 48th hour postoperatively. We also assessed the time to first flatus to measure the extent of paralytic ileus and the quality of recovery-15 (QoR-15) questionnaire.

Results: Postoperative opioid consumption was significantly lower in the QLB group than in the control group at 6, 24, and 48h after surgery (P < 0.05). The pain intensity at rest and on movement was significantly lower in the QLB group than in the control group during the first 24 hours after surgery (P < 0.05). The incidence of postoperative nausea and vomiting, time to first flatus, and QoR-15 score did not show significant differences.

Conclusion: Preoperative unilateral QLB successfully decreased postoperative pain and opioid consumption after laparoscopic nephrectomy and could be an option for analgesia after laparoscopic nephrectomy.

Keywords: laparoscopic nephrectomy; opioid consumption; postoperative pain; quadratus lumborum block; ultrasound-guided block.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2020 Kwak et al.

Figures

Figure 1
Figure 1
(A) Patient was positioned in lateral decubitus position. A high-frequency linear probe attached in the area of posterior to triangle of Petit. (B) Preinjection and (C) postinjection images of quadratus lumborum blocks. Triangle indicates needle. Asterisk represents the spread of local anesthetics. Abbreviations: EO, external oblique muscle; IO, internal oblique muscle; TA, transversus abdominis muscle; QL, quadratus lumborum muscle.
Figure 2
Figure 2
The Consolidated Standards of Reporting Trials (CONSORT) flowchart of the study. Abbreviations: QL, quadratus lumborum; NRS, numeric rating scale; QoR-15, questionnaire of quality of recovery with 15 items.
Figure 3
Figure 3
Pain intensities in the control group and QL block group at 2, 6, 24, and 48 h after surgery. The box plot demonstrates the median with interquartile range (IQR). The whiskers represent 1.5 times the IQR or the limits of the numeric rating scale of pain (0–10). Outliers are data beyond theses values and denoted by small circles. Abbreviation: QL, quadratus lumborum.
Figure 4
Figure 4
The incisions in the laparoscopic nephrectomy. Our laparoscopic nephrectomy has one paramedian incision for removing excised specimen and three working ports, which lie on the ipsilateral subcostal line.

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