Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Decreases Persistent Postoperative Pain Severity in Patients Undergoing Both Open and Laparoscopic Nephrectomies-A Randomized Controlled Trial

Michał Borys, Patrycja Szajowska, Mariusz Jednakiewicz, Grzegorz Wita, Tomasz Czarnik, Marcin Mieszkowski, Bułat Tuyakov, Piotr Gałkin, Mansur Rahnama-Hezavah, Mirosław Czuczwar, Paweł Piwowarczyk, Michał Borys, Patrycja Szajowska, Mariusz Jednakiewicz, Grzegorz Wita, Tomasz Czarnik, Marcin Mieszkowski, Bułat Tuyakov, Piotr Gałkin, Mansur Rahnama-Hezavah, Mirosław Czuczwar, Paweł Piwowarczyk

Abstract

Background: New regional techniques can improve pain management after nephrectomy.

Methods: This study was a randomized controlled trial conducted at two teaching hospitals. Patients undergoing elective open and laparoscopic nephrectomy were eligible to participate in the trial. A total of 100 patients were divided into a quadratus lumborum block (QLB) group (50 patients) and a control (CON) group (50 patients). At the end of surgery, but while still under general anesthesia, unilateral QLB with ropivacaine was performed on the side of nephrectomy for patients in the QLB group. The main measured outcome of this study was oxycodone consumption via a patient-controlled anesthesia (PCA) pump during the first 24 h following surgery; other measured outcomes included postoperative pain intensity assessment, patient satisfaction with pain management, and persistent pain evaluation.

Results: Patients undergoing QLB needed less oxycodone than those in the CON group (34.5 mg (interquartile range 23 to 40 mg) vs. 47.5 mg (35-50 mg); p < 0.001). No difference between the groups was seen in postoperative pain intensity measured on the visual analog scale, except for the evaluation at hour 2, which was in favor of the QLB group (p = 0.03). Patients who received QLB were more satisfied with postoperative pain management than the CON group. Persistent postoperative pain was assessed with the Neuropathic Pain Symptom Inventory (NPSI) at months 1, 3, and 6, and was found to be significantly lower in the QLB group at each evaluation (p < 0.001). We also analyzed the impact of the surgery type on persistent pain severity, which was significantly lower after laparoscopic procedures than open procedures at months 1, 3, and 6.

Conclusions: QLB reduces oxycodone consumption in patients undergoing open and laparoscopic nephrectomy and decreases persistent pain severity months after hospital discharge.

Keywords: nephrectomy; neuropathic pain symptom inventory; patient-controlled analgesia; persistent postoperative pain; quadratus lumborum block.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart; CON: control group; QLB: quadratus lumborum block group.
Figure 2
Figure 2
Consumption of oxycodone via patient-controlled analgesia pump during the first 24 postoperative hours; CON: control group; QLB: quadratus lumborum block group; * statistically significant.
Figure 3
Figure 3
Persistent pain severity measured with the NPSI at months 3 and 6.
Figure 4
Figure 4
Receiver operating characteristic curve; The receiver operating characteristic curve of the persistent pain model was calculated with logistic regression.

References

    1. Alper I., Yüksel E. Comparison of Acute and Chronic Pain After Open Nephrectomy Versus Laparoscopic Nephrectomy: A Prospective Clinical Trial. Medicine. 2016;95:e3433. doi: 10.1097/MD.0000000000003433.
    1. Koo C.H., Ryu J.H. Anesthetic Considerations for Urologic Surgeries. Korean J. Anesthesiol. 2020;73:92–102. doi: 10.4097/kja.19437.
    1. Santonastaso D.P., de Chiara A., Musetti G., Bagaphou C.T., Gamberini E., Agnoletti V. Ultrasound Guided Erector Spinae Plane Block for Open Partial Nephrectomy: Only an Alternative? J. Clin. Anesth. 2019;56:55–56. doi: 10.1016/j.jclinane.2019.01.036.
    1. Kwak K.H., Baek S.I., Kim J.K., Kim T.H., Yeo J. Analgesic Effect of Ultrasound-Guided Preoperative Unilateral Lateral Quadratus Lumborum Block for Laparoscopic Nephrectomy: A Randomized, Double-Blinded, Controlled Trial. J. Pain Res. 2020;13:1647–1654. doi: 10.2147/JPR.S257466.
    1. Dam M., Hansen C., Poulsen T.D., Azawi N.H., Laier G.H., Wolmarans M., Chan V., Bendtsen T.F., Børglum J. Transmuscular Quadratus Lumborum Block Reduces Opioid Consumption and Prolongs Time to First Opioid Demand after Laparoscopic Nephrectomy. Reg. Anesth. Pain Med. 2021;46:18–24. doi: 10.1136/rapm-2020-101745.
    1. Misiołek H., Zajączkowska R., Daszkiewicz A., Woroń J., Dobrogowski J., Wordliczek L., Owczuk R. Postoperative Pain Management—2018 Consensus Statement of the Section of Regional Anaesthesia and Pain Therapy of the Polish Society of Anaesthesiology and Intensive Therapy, the Polish Society of Regional Anaesthesia and Pain Therapy, the Polish Association for the Study of Pain and the National Consultant in Anaesthesiology and Intensive Therapy. Anaesthesiol Intensive Ther. 2018;50:173–199. doi: 10.5603/AIT.2018.0026.
    1. Blanco R., McDonnell J.G. Optimal Point of Injection: The Quadratus Lumborum Type I and II Blocks. [(accessed on 14 May 2021)]; Available online: .
    1. Baidya D.K., Maitra S., Arora M.K., Agarwal A. Quadratus Lumborum Block: An Effective Method of Perioperative Analgesia in Children Undergoing Pyeloplasty. J. Clin. Anesth. 2015;27:694–696. doi: 10.1016/j.jclinane.2015.05.006.
    1. Cardoso J., Sá M., Reis H., Almeida L., Sampaio J., Pinheiro C., Machado D. Type II Quadratus Lumborum Block for a Sub-Total Gastrectomy in a Septic Patient. Rev. Bras. Anestesiol. 2018;68:186–189. doi: 10.1016/j.bjan.2016.09.009.
    1. Borys M., Zamaro A., Horeczy B., Gęszka E., Janiak M., Węgrzyn P., Czuczwar M., Piwowarczyk P. Quadratus Lumborum and Transversus Abdominis Plane Blocks and Their Impact on Acute and Chronic Pain in Patients after Cesarean Section: A Randomized Controlled Study. Int. J. Environ. Res. Public Health. 2021;18:3500. doi: 10.3390/ijerph18073500.
    1. Gupta A., Sondekoppam R., Kalagara H. Quadratus Lumborum Block: A Technical Review. Curr. Anesthesiol. Rep. 2019;9:257–262. doi: 10.1007/s40140-019-00338-9.
    1. Aditianingsih D., Pryambodho A.N., Tantri A.R., Mochtar C.A. A Randomized Controlled Trial on Analgesic Effect of Repeated Quadratus Lumborum Block Versus Continuous Epidural Analgesia Following Laparoscopic Nephrectomy. BMC Anesthesiol. 2019;19:221. doi: 10.1186/s12871-019-0891-7.
    1. Zhu M., Qi Y., He H., Lou J., Pei Q., Mei Y. Analgesic Effect of the Ultrasound-Guided Subcostal Approach to Transmuscular Quadratus Lumborum Block in Patients Undergoing Laparoscopic Nephrectomy: A Randomized Controlled Trial. BMC Anesthesiol. 2019;19:154. doi: 10.1186/s12871-019-0825-4.
    1. Bouhassira D., Attal N., Fermanian J., Alchaar H., Gautron M., Masquelier E., Rostaing S., Lanteri-Minet M., Collin E., Grisart J., et al. Development and Validation of the Neuropathic Pain Symptom Inventory. Pain. 2004;108:248–257. doi: 10.1016/j.pain.2003.12.024.
    1. Borys M., Hanych A., Czuczwar M. Paravertebral Block Versus Preemptive Ketamine Effect on Pain Intensity After Posterolateral Thoracotomies: A Randomized Controlled Trial. J. Clin. Med. 2020;9:793. doi: 10.3390/jcm9030793.
    1. Borys M., Potręć-Studzińska B., Wiech M., Piwowarczyk P., Sysiak-Sławecka J., Rypulak E., Gęca T., Kwaśniewska A., Czuczwar M. Transversus Abdominis Plane Block and Quadratus Lumborum Block Did Not Reduce the Incidence or Severity of Chronic Postsurgical Pain Following Cesarean Section: A Prospective, Observational Study. Anaesthesiol. Intensive Ther. 2019;51:257–261. doi: 10.5114/ait.2019.88071.
    1. Owen M., Lorgelly P., Serpell M. Chronic Pain Following Donor Nephrectomy—A Study of the Incidence, Nature and Impact of Chronic Post-Nephrectomy Pain. Eur. J. Pain. 2010;14:732–734. doi: 10.1016/j.ejpain.2009.11.013.

Source: PubMed

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