Preoperative versus Postoperative Ultrasound-Guided Quadratus Lumborum Block for Postoperative Analgesia Following Radical Nephrectomy, A Comparative Study

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Abstract Background The QLB is an effective analgesic technique for various abdominal wall incisions. The QLB covers T7 to L1 dermatomes by the spread of LA drugs either into the paravertebral space or in the thoracolumbar plane, through iliohypogastric and ilioinguinal nerves, A and C fiber nociceptors, mechanoreceptors and high-density network of lumbar sympathetic fibers. Objective To compare the effectiveness of ultrasound-guided preoperative to postoperative QLB on the effectiveness and duration of postoperative analgesia represented as time of first analgesia requested by patients. Patients and Methods After approval of research ethical committee of Ain Shams University Hospitals, this prospective double blinded randomized clinical study was conducted between April 2023 till September 2023, written consent was taken from all participants after explaining the procedure. One hundred and eight patients were included. later on. eight patient were excluded due to bleeding, failed block, duration of surgery more than 180 minutes. Included patients were divided into 2 groups 50 each. Results The current study also calculated and compared the standard deviation for each of the two groups analyzed, as well as the postoperative NRS score, initial time to rescue analgesia, and total amount of opioids (Nalbuphine) administered in the first 24 h. When compared to the postoperative QLB group (Group B), preoperative QLB patients (Group A) showed higher values. Postoperative QLB was found to be more effective than preoperative QLB in this clinical trial. Group B was found to be superior to Group A in terms of analgesia (Nalbuphine), total Nalbuphine consumption, and NRS score. Group A had higher pain ratings and were the first to rescue analgesia. There are no many studies were done comparing preoperative versus postoperative plan block especially with QLB in postoperative pain management and that’s the gab of knowledge in our study. Conclusion Postoperative administration of QLB in nephrectomy provides a prolonged duration of postoperative analgesia, with reduced analgesic requirements, a better quality of analgesia in terms of NRS compared to preoperative administration of QLB.