Abstract
BackgroundThe postoperative analgesic effect of transmuscular quadratus lumborum block (QLB-TM) in patients following lower abdominal surgeries has been identified; however, the efficacy of QLB using the lateral approach (QLB-L) is still in debate. Therefore, this retrospective study was conducted to investigate the effect of a single-shot block with QLB-L on postoperative analgesia for patients undergoing percutaneous nephrolithotomy (PCNL).MethodsThe medical information of the patients undergoing PCNL was retrieved from the electronic charter system (Medisystem, Suzhou, China) in our Nanjing Drum Tower Hospital during the period of Jan/2019 to Jun/2019. Among the total of 57 patients, there are 17, 18, and 22 patients subjected to QLB-L, QLB-TM, or routine treatment, respectively. The primary observational parameter was to assess postoperative pain with visual analog scales (VAS) at rest 30 min after extubation, 24 h, and 48 h after surgery, respectively. The secondary observatory endpoints, including the consumption of intraoperative opioids, the cumulative dose of non-steroid anti-inflammatory drugs (NSAIDs) and the incidence of adverse events related to postoperative analgesia, were evaluated as well.ResultsThe static VAS score at 24 h after surgery and the intraoperative consumption of sufentanil were significantly lower in patients receiving either intervention of QLB-L or QLB-TM as compared with those receiving routine treatment. However, one shot of QLB had no impact on VAS scores at 30 min post-extubation, 48 h after PCNL procedure compared with the patients receiving routine treatment. The percentage of non-ambulatory patients within 24 h post-PCNL was significantly higher in the QLB-TM group compared with the routine treatment group (P = 0.04). There were no significant differences in the incidence of postoperative nausea and vomit (PONV), itches, respiratory depression, the time for the first defecation, and the length of hospital stay (LOS) among the three groups.ConclusionsQLB-L procedure may exert as equivalent as QLB-TM in terms of abrogating postoperative pain within 24 h post-surgery and decreasing intraoperative sufentanil consumption in patients undergoing PCNL procedure as well. The caution should be taken to avoid lower extremities weakness in the patients after QLB-TM within the first 24 h post-PCNL procedure.
Highlights
The postoperative analgesic effect of transmuscular quadratus lumborum block (QLB-TM) in patients following lower abdominal surgeries has been identified; the efficacy of QLB using the lateral approach (QLB-L) is still in debate
The postoperative pain scores assessed using visual analog scales (VAS) were collected at 30 min after removal of the endotracheal tube in a post-anesthesia care unit (PACU), 24, 48 h after surgery in the ward, respectively
The patients receiving either type of QLB had lower VAS values at rest 24 h after surgery compared with the patients under routine analgesic treatment (QLB-TM vs Con: 1(0–2) vs 2(1.9–3.1), P < 0.01; QLB-L vs Con: 0(0–1) vs 2(1.9–3.1), P < 0.01)
Summary
The postoperative analgesic effect of transmuscular quadratus lumborum block (QLB-TM) in patients following lower abdominal surgeries has been identified; the efficacy of QLB using the lateral approach (QLB-L) is still in debate. Percutaneous nephrolithotomy (PCNL) is the treatment of choice for patients with multiple or complex kidney or upper urinary tract stones, which necessitates the meticulous multi-modality analgesia due to mild to moderate pain originated from renal capsule dilation or nephrostomy-tube-related stress during the first 24 h after operation [1]. Alternative options such as thoracic paravertebral block (TPVB) or quadratus lumborum block (QLB) technique are strongly recommended as an appropriate adjunctive to systemic intravenous analgesia for pain control [2,3,4]. The studies from Blanco and Kadam et al, suggested that QLB-L provided adequate postoperative analgesia in lower abdominal surgeries as well, given the local anesthetics were administered beneath the middle layer of the thoracolumbar fascia lateral to the QL muscle to acquire adequate cephalad-distribution with the blockade of T9–12 spinal nerves [11, 12]
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