Dataset Information

Lateral Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Laparoscopic Surgery: A Randomized Controlled Study.

ABSTRACT:

Background

After laparoscopic abdominal surgery, we aim to evaluate the analgesic efficiency of US-directed bilateral transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB).

Methods

50 patients aged 18-60 years listed for elective laparoscopic abdomen operation were registered in this study. Cases were randomly allocated into two similar groups: TAPB and QLB groups. The first outcome was the growing morphine consumption on the 1^st day postoperatively. The second outcome involved VAS score, first analgesic necessities, and any postoperative complications. Statistical analysis was done with the 2-sample t-test, and Mann-Whitney U testing was utilized to compare medians for skewed end points. Qualitative data were introduced as numbers and percentages, and chi-squared testing was utilized to determine the significance.

Results

The median cumulative morphine consumptions on the 1st day were high significantly in the TAPB group than in the QLB group (6 mg [6, 9] vs. 3 mg [3, 6], p value ≤0.0001]). The QLB group showed an increase in the median of the time to the first analgesic request in comparison with the TAPB group (17 hours [12, 24] vs. 8 hours [6, 24], p ≤ 0.001). In addition, on the 1st day, the mean VAS scoring at rest was lower in the QLB group.

Conclusion

In comparison to the TAPB, the QL block delivers more successful pain relief, has an extended period of analgesic actions, extends interval to the 1^st analgesic necessity, is accompanied with lesser morphine consumptions, and may be utilized in multimodal analgesia and opioid-sparing regimens after that laparoscopic operation. This trial is registered with NCT04553991.

SUBMITTER: Fargaly OS

PROVIDER: S-EPMC8979728 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

Lateral Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Laparoscopic Surgery: A Randomized Controlled Study.

Fargaly Omar Sayed OS Boules Maged Labib ML Hamed Mohamed Ahmed MA Aleem Abbas Mohammed Abdel MA Shawky Mohammed Ahmed MA

Anesthesiology research and practice 20220328

<h4>Background</h4>After laparoscopic abdominal surgery, we aim to evaluate the analgesic efficiency of US-directed bilateral transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB).<h4>Methods</h4>50 patients aged 18-60 years listed for elective laparoscopic abdomen operation were registered in this study. Cases were randomly allocated into two similar groups: TAPB and QLB groups. The first outcome was the growing morphine consumption on the 1<sup>st</sup> day postoperativel ...[more]

PMID: 35386840

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Project description:BackgroundCurrently, the prevalence of obesity is on the rise annually. Bariatric surgery stands out as the most efficacious approach for addressing obesity. Obese patients are more prone to experience moderate to severe pain after surgery due to lower pain thresholds. Regional block, as an important component of multimodal analgesia in bariatric surgery, is crucial in reducing opioid consumption and alleviating postoperative pain in patients undergoing bariatric surgery. Transversus abdominis plane block (TAPB) has gained widespread utilization in bariatric surgery; however, its limitation of inadequate reduction of visceral pain in obese patients remains a significant concern. Therefore, it is imperative to explore new and more efficient strategies for analgesia. Quadratus lumborum block (QLB) has emerged as a popular nerve block in recent years, frequently utilized in conjunction with general anesthesia for abdominal surgery. In the cadaver study of QLB, it was confirmed that the dye level could reach up to T6 when using the subcostal anterior quadratus lumborum muscle approach, which could effectively reduce the incision pain and visceral pain of bariatric surgery patients during the perioperative period. However, there is currently a lack of research on the use of subcostal anterior QLB in patients undergoing bariatric surgery. Our study aims to investigate whether subcostal anterior QLB can provide superior perioperative analgesic efficacy for bariatric surgery under general anesthesia compared to TAPB, leading to reduced postoperative opioid consumption and a lower incidence of postoperative nausea and vomiting (PONV).Methods and designThis study is a prospective, randomized controlled trial aiming to recruit 66 patients undergoing bariatric surgery. The participants will be randomly allocated into two groups in a 1:1 ratio: subcostal anterior QLB group (n = 33) and TAPB group (n = 33). The study aims to investigate the efficacy of subcostal anterior QLB and TAPB in obese patients who are scheduled to undergo bariatric surgery. Our primary outcome is to observe the amount of opioids used in the two groups 24 h after operation. The secondary outcomes included VAS of pain during rest/activity after operation, the type and dose of additional analgesics, the occurrence and severity of PONV, the type and dose of additional antiemetic drugs, postoperative anesthesia care unit (PACU) time, time of first postoperative exhaust, time to first out of bed activity, time to first liquid diet and postoperative admission days.DiscussionOpioid analgesics are prone to causing adverse reactions such as nausea, vomiting, and respiratory depression, especially in obese patients. Multimodal analgesia, including nerve block, can effectively reduce the dose of opioids and alleviate their adverse effects. Currently, TAPB is the most prevalent nerve block analgesia method for abdominal surgery. Recent studies have indicated that subcostal anterior QLB offers advantages over TAPB, including a wider block plane, faster onset, and longer maintenance time. It is not clear which of the two nerve block analgesia techniques is better for postoperative analgesia in patients undergoing bariatric surgery. Our objective in this investigation is to elucidate the superior method between TAPB and subcostal anterior QLB for postoperative pain management in bariatric surgery.Trial registrationChiCTR ChiCTR2300070556. Registered on 17 April 2023.

Project description:Study objectivePatients undergoing open nephrectomy surgery experience severe perioperative pain, which is primarily due to incision of several muscles. Abdominal wall blocks are known to reduce pain without causing epidural-associated hypotension. We conducted this study to compare unilateral ultrasound-guided transmuscular quadratus lumborum block and posterior transversus abdominis block in combination with general anesthesia alone in terms of intraoperative and postoperative analgesics and hemodynamics and postoperative complications.MethodsThis was a randomized, double-blinded, controlled trial conducted in the operating room. This study included 48 patients aged 20-60 years, with ASA I and II, and a body mass index ≤ 30kg.m-2 who were scheduled for open nephrectomy procedure.The 48 patients scheduled for nephrectomy were randomly allocated into one of the following three groups after induction of general anesthesia: Group A (n=16) received USG transmuscular QLB; Group B (n=16) received unilateral USG posterior transversus abdominis plane (TAP) block; and Group C (n=16; control group) did not receive any blocks. Introperative fentanyl consumption, and hemodynamics (heart rate and mean arterial pressure (MAP)) were recorded after anesthesia induction, at surgical incision, and every 15min till the end of surgery. Visual Analogue Scale (VAS) was evaluated immediately at 30min and 1,2,4,6, and 12hours postoperatively. The time of first analgesic request was also recorded.ResultsIntraoperative fentanyl consumption (μg) was significantly lower in Groups A and B (164.69±27.35 and 190.31±44.48, respectively) than in Group C (347.50±63.64) (p<0.001). Postoperatively, total pethidine consumption was significantly lower in Groups A and B than in Group C (85.31±6.68, 84.06±4.17mg, and 152.19±43.43mg, respectively) (p<0.001. Time to rescue analgesia was longer in Groups A and B than in Group C (138.75±52.39min, 202.50±72.25min, and 37.50±13.42min, respectively) (p<0.001). VAS score was significantly lower in Groups A and B than in Group C at 30min and 1, 2, 4, and 6hours postoperatively.ConclusionTransmuscular quadratus lumborum block and posterior transversus abdominis blocks were effective in providing perioperative analgesia in patients undergoing open nephrectomy. However, quadratus lumborum block provided superior analgesia.

Dataset Information

Lateral Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Laparoscopic Surgery: A Randomized Controlled Study.

Background

Methods

Results

Conclusion

Publications

Lateral Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Laparoscopic Surgery: A Randomized Controlled Study.

Similar Datasets

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