Randomized controlled trial of a quadratus lumborum block with liposomal bupivacaine for postoperative analgesia in laparoscopic donor nephrectomy

Hans Albin Gritsch, Nathan Osbun, Tristan Grogan, Katherine E Fero, Parisa Partownavid, Joel Stockman, Namjeh Sadoughi, Edward Park, Eric Miller, Jeremy Blumberg, Michelle McDonald, Nicholas Cowan, Nikhil Shah, Siamak Rahman, Hans Albin Gritsch, Nathan Osbun, Tristan Grogan, Katherine E Fero, Parisa Partownavid, Joel Stockman, Namjeh Sadoughi, Edward Park, Eric Miller, Jeremy Blumberg, Michelle McDonald, Nicholas Cowan, Nikhil Shah, Siamak Rahman

Abstract

Perioperative pain management is an important consideration in early recovery and patient satisfaction following laparoscopic donor nephrectomy. Transmuscular quadratus lumborum block has been described to reduce pain and opioid usage following several abdominal surgeries. In this prospective single-blind randomized controlled trial, we compared 52 patients who adhered to our institutional donor nephrectomy Early Recovery After Surgery pathway, which includes a laparoscopic-guided transversus abdominus plane block, to 40 patients who additionally received a transmuscular quadratus lumborum block with liposomal bupivacaine. Compared to control patients, those who received the block spent longer in the operating room prior to the surgical start (65.4 vs. 51.6 min, P < .001). Both groups had similar total hospital length of stay (33.3 h vs. 34.4 h, P = .61). Pain scores from postoperative days 0-30, number of patients requiring opioids, postoperative nausea, and pain management satisfaction were similar between both groups. Patients who received the block consumed less opioid on postoperative day 1 compared to controls (P = .006). No complications were attributable to the block. The quadratus lumborum block provides a safe pain management adjunct for some patients, and may reduce opioid use in the early postoperative period when combined with our standard institutional protocol for kidney donors.

Trial registration: ClinicalTrials.gov NCT03294109.

Keywords: clinical trial; donor nephrectomy; donors and donation: living.

Conflict of interest statement

The authors of this manuscript have no conflicts of interest to disclose as described by Clinical Transplantation.

© 2021 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Diagram of participant flow during the trial enrollment
FIGURE 2
FIGURE 2
(A) Average visual analog pain scores of participants were similar in the control group and the quadratus lumborum block group. Pain was assessed immediately post‐operatively in the PACU on post‐operative (POD) 3, 5, 10, and 30. (B) Pain medication use was similar between the control group and the quadratus lumborum block group on POD 3, 5, 10, and 30. The majority of patients in both groups did not require opioids by POD 5

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Source: PubMed

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