Effect of Ultrasound Guided Quadratus Lumborum Block as Postoperative Analgesia after Laparoscopic Cholecystectomy

Abstract

Abstract Background Poorly controlled acute pain after abdominal surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay and an increased likelihood of chronic pain. Aim of the Work The aim of this study was to assess the postoperative analgesic efficacy of quadratus lumborum block (QLB) compared to general anesthesia with multimodal routes of analgesia as paracetamol, ketorolac and morphine after laparoscopic cholecystectomy regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods The study was conducted on 60 randomly chosen patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or Il scheduled for elective laparoscopic cholecystectomy in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 30 patients each: Group A: (n = 30): patients received general anesthesia followed by QLB at the end of the operation and before emergence of GA, with rescue drug morphine 0.05 mg/kg IV, Group B: (n = 30): patients received general anesthesia only, with post-operative control of pain using multimodal routes of analgesia as paracetamol I gm IVI 16 hrs, ketorolac 30 mg in 100 ml normal saline solution every 12 hrs and rescue drug morphine 0.05 mg [kg IV. Results The results of the study revealed that the Patients receiving QLB had significantly lower pain scores at rest for the whole first 24 hrs while upon coughing there was no difference in the first 6 hrs between the two groups and lower pain in 12, 18, 24 hrs in QLB group postoperatively and decrease total need of analgesic in first 24 hrs postoperatively compared with patients who received multimodal routes of analgesia. Conclusion Bilateral QLB was effective in reducing postoperative pain scores at rest and upon coughing and lower total 24 hrs postoperative opioid and analgesic consumption after laparoscopic cholecystectomy under general anesthesia, compared to multimodal routes of analgesia, This technique can be a promising mode of postoperative analgesia. Use of adjuncts of continuous catheters might be used in the next studies for prolonging the duration of block.