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

doi:10.3390/jcm10163590

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.

Highlights

A multimodal analgesia approach is recommended following nephrectomy, some individuals still suffer from severe pain after the procedure [1]
Written informed consent was obtained from each patient, and the study was conducted in accordance with the principles for medical research involving human subjects of the Declaration of Helsinki
Adult patients younger than 80 years who were scheduled for nephrectomy procedures could volunteer to participate in the study

Summary

Introduction

A multimodal analgesia approach is recommended following nephrectomy, some individuals still suffer from severe pain after the procedure [1]. Regional anesthesia techniques may improve postoperative pain management and reduce the opioid dosage in the period following renal surgery [2]. Novel blocks have recently been proposed as analgesic options in patients undergoing laparoscopic or open nephrectomy [3,4,5], and such approaches are considered part of multimodal analgesia in the postoperative period [6]. Quadratus lumborum block (QLB) is a relatively new regional anesthesia technique; it was developed by Blanco [7] and has been proposed as an analgesic alternative for use after many types of surgical procedures [8,9,10]. There were differences in the type of block, injection site, and postoperative pain management, and, to our knowledge, none of the RCTs considered QLB following open nephrectomies.

Methods

Results

Conclusion