Anterior Quadratus Lumborum Block Research Articles

Anterior quadratus lumborum blocks for postoperative pain treatment following intra-abdominal surgery: A systematic review with meta-analyses and trial sequential analyses.

The anterior quadratus lumborum (QL) block may be used for postoperative pain management for intra-abdominal surgeries, but the evidence is uncertain. We aimed to investigate the benefit and harm of the anterior QL block compared to placebo/no block for intra-abdominal surgery. We searched Medline, Embase, and CENTRAL for randomized controlled trials investigating anterior QL block for postoperative pain management for adult patients undergoing any intra-abdominal surgery. The two co-primary outcomes were cumulative 24-h opioid consumption and serious adverse events. We performed meta-analysis, trial sequential analysis (TSA), assessed the risk of bias, and present the certainty of evidence with the Grading of Recommendations, Assessment, Development and Evaluation approach. Thirty-five trials randomizing 2418 patients were included in the meta-analyses. Anterior QL block may reduce cumulative 24-h intravenous opioid consumption compared to placebo/no block (MD -10.42 mg, 96.7% CI -14.83 to -6.01, TSA-adjusted CI -17.03 to -3.82, p < .01). Two trials reported on SAEs. Anterior QL block may have little to no effect on the number of serious adverse events compared to placebo (RR 1.49, 96.7% CI 0.19 to 11.47, p = .68), but the evidence is very uncertain. All trial results were assessed as being high risk of bias. The anterior QL block may reduce cumulative 24-h opioid consumption. Reported serious adverse events were few and the anterior QL block may have little to no effect on the number of SAEs, but the evidence was very uncertain.

Intravenous Lidocaine Compared with Quadratus Lumborum Block on Postoperative Analgesia Following Laparoscopic Renal Surgery: Protocol for a Randomized Noninferiority Trial.

Patients undergoing laparoscopic renal surgery often experience significant postoperative pain. Quadratus lumborum block (QLB) provides effective postoperative pain control after laparoscopic procedures, while lidocaine administered intravenously also exerts analgesic effects for surgical patients. We design this trial to compare the effects of i.v. lidocaine infusion with QLB on postoperative analgesia in patients undergoing laparoscopic renal surgery. In this randomized noninferiority trial, a total of 120 adult patients undergoing laparoscopic renal surgery will be randomized to receive either i.v. lidocaine or unilateral QLB for postoperative pain management. Lidocaine will be i.v. administered at 1.5 mg/kg (ideal body weight) over 10min during anesthesia induction, followed by an infusion of 1.5 mg/kg/h intraoperatively and in a post-anesthesia care unit. Ultrasound-guided anterior QLB with 0.375% ropivacaine 30 mL will be conducted before the start of surgery. Patient-controlled i.v. sufentanil will be used for pain relief during the first 48h after surgery. The primary outcome is the cumulative sufentanil consumption during 0-24h postoperatively, with a noninferiority margin of 5μg. Secondary outcomes include pain intensity at rest and on coughing at 1, 6, 24, and 48h postoperatively; sufentanil consumption within 24-48h after surgery; rescue analgesic use within 0-48h after surgery; nausea and vomiting within 0-48h postoperatively; and quality of recovery at 24 and 48h after surgery. The results of this trial will add to the clinical evidence for improving postoperative pain management in patients who undergo laparoscopic renal surgery. Chinese Clinical Trial Registry (ChiCTR2400082974).

Ultrasound-guided bilateral anterior quadratus lumborum block at the lateral supra-arcuate ligament in patients undergoing laparoscopic radical gastrectomy: A randomised controlled study

Objective: Ultrasound-guided bilateral anterior quadratus lumborum block at the lateral supra-arcuate ligament has recently been proposed as an effective analgesia for abdominal surgery. To test the hypothesis that this novel technique was a viable alternative approach of conventional thoracic epidural analgesia for laparoscopic radical gastrectomy. Methods: Three hundred patients scheduled for laparoscopic radical gastrectomy were randomised 1:1 into the anterior quadratus lumborum block group: receiving the novel regional analgesia, and the thoracic epidural analgesia group: receiving thoracic epidural anaesthesia. The primary endpoint was intraoperative consumption of propofol and remifentanil. Intention-to-treat analysis was performed for all variables. Results: At five and ten minutes after block, anterior quadratus lumborum block group achieved more dermatomes coverage of the sensory block with both p &lt; 0.001. Intraoperative consumption of propofol and remifentanil was comparable between two groups (1116.21 ± 199.76 versus 1166.45 ± 125.31µg, p = 0.245 and remifentanil 1.83 ± 0.41 versus 1.81 ± 0.37ng, p = 0.988). However, anterior quadratus lumborum block group was associated with less intraoperative consumption of norepinephrine and atropine, shorter time to urinary catheter removal and out-of-bed activity than the thoracic epidural anaesthesia group. No significant difference in extubation time, pain scores at rest and exercising at all time points following surgery was observed between the two groups. Conclusions: Compared with conventional thoracic epidural anaesthesia, the novel technique was an equivalent effective component of multimodal analgesic protocol for laparoscopic radical gastrectomy. There were some advantages, including shorter procedure time, more reliable dermatomal coverage, shorter duration of urinary catheterisation and earlier time of out-of-bed activity to enhance recovery after surgery. Trial registration: The study was registered in the Chinese Clinical Trial Registry on 2 November 2022 (ChiCTR2200065325).

Effects of anterior quadratus lumborum block versus erector spinae plane block on postoperative acute pain in percutaneous nephrolithotomy: a prospective, observational study

BackgroundThe study aimed to compare the pain-relieving effectiveness of anterior quadratus lumborum block (QLB3) and erector spinae plane block (ESPB), both of which have been documented to provide relief during abdominal surgery.MethodsThis prospective observational study, conducted between February and July 2023, included 96 patients who had undergone percutaneous nephrolithotomy (PCNL). Patients were divided into three groups: QLB3, ESPB, and control (no block) and received the corresponding nerve block in the preanesthetic room for regional block. Cumulative morphine consumption during the initial 24 h after PCNL, numerical rating scale resting/movement scores, intraoperative remifentanil usage, rescue analgesic requirements, time when the first analgesic was requested, and postoperative nausea and vomiting scores were documented and compared between the groups.ResultsTotal median morphine consumption in the first 24 h postoperatively was similar in the QLB3 and ESPB groups but higher in the control group (QLB3, 7 mg [(Q1-Q3) 7–8.5]; ESPB, 8 mg [6.5–9]; control, 12.5 [10–17]; P < 0.001). Similarly, median intraoperative remifentanil consumption did not differ between the block groups but was higher in the control group (QLB3, 1082 µg [IQR 805.5–1292.7]; ESPB, 1278 µg [940.2–1297.5]; control, 1561 µg [1315–2068]; P < 0.001). The number of patients receiving rescue analgesic medication was similar in the block groups but higher in the control group (QLB3, n = 9 [30%]; ESPB, n = 14 [46.7%]; control, n = 21 [70%]; P = 0.008).ConclusionsQLB3 and ESPB were adequate and comparable in providing postoperative analgesia as part of multimodal analgesia after PCNL.Trial registrationThe study was registered on ClinicalTrials.gov (Identifier: NCT05822492).

Comparison of postoperative analgesia effects between subcostal anterior quadratus lumborum block and transversus abdominis plane block in bariatric surgery: a prospective randomized controlled study

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.

Anterior quadratus lumborum block for analgesia after living-donor renal transplantation: a double-blinded randomized controlled trial

IntroductionLimited non-opioid analgesic options are available for managing postoperative pain after renal transplantation. We aimed to investigate whether the unilateral anterior quadratus lumborum (QL) block would reduce postoperative opioid consumption...

Anterior quadratus lumborum block provided superior pain control and reduced opioid consumption in kidney transplantation: A randomized controlled trial.

The research aimed to assess the effectiveness of inside-out anterior quadratus lumborum (QL3) block and local wound infiltration in managing postoperative pain and total morphine dosage following kidney transplantation. In this prospective, randomized, double-blind study; 46 end-stage renal disease patients undergoing kidney transplantation were randomly allocated into 2 groups: a QL group (n = 23) receiving 20 mL of 0.25% bupivacaine using the ultrasound-assisted inside-out technique before wound closure, while the local wound infiltration (LA) group (n = 23) receiving the same dose around the surgical wound and drain at the time of skin closure. The primary outcome measure was the numerical pain rating scale, with secondary outcomes including amount of morphine consumption at various postoperative time points (2nd, 4th, 6th, 12th, 18th and 24th hours). Patients in the QL group had significantly lower numerical rating scale scores at the 2nd and 4th hours, both at rest and during movement (P < .05). Although pain scores at rest and during movement at later time points were lower in the QL group compared to the LA group, these differences were not statistically significant. Cumulative morphine consumption at postoperative 4th, 6th, 12th, 18th and 24th hours was significantly lower in the QL group (P < .05). No patients experienced complications from the QL3 block. Ultrasound-assisted inside-out QL3 block significantly reduced postoperative pain levels at the 2nd and 4th hours, both at rest and during movement, and led to a reduction in cumulative morphine consumption from the 4th hour postoperatively, and persisting throughout the 24-hour period.

Ultrasound-guided pericapsular nerve group block and anterior quadratus lumborum block for analgesia in hip arthroplasty: a prospective randomized comparative study

Background and objective The ideal regional analgesic block following hip arthroplasty is not yet defined. This trial aimed to compare the efficacy of anterior quadratus lumborum block (QLB) and pericapsular nerve group (PENG) block analgesia in patients subjected to hip arthroplasty under spinal anesthesia. Patients and methods Following ethical approval, 70 participants scheduled for hip arthroplasty under subarachnoid block were included in the current prospective randomized double-blinded comparative study. They were randomly assigned into two equal groups (n=35 each): anterior QLB group and PENG group. The primary outcome was the time to the first postoperative request for analgesia. The secondary outcomes were assessment of pain during the positioning for giving spinal anesthesia, visual analog scale (VAS) pain scores during movement and at rest, the total opioid consumption during the first postoperative 24 h, motor power assessment of the hip joint, and block and opioid-related complications. Results There were no statistically significant differences between the two studied groups regarding the time to first analgesic request, pain VAS scores at rest and on movement, total morphine consumption, positing pain, hip motor recovery, and block and opioid-related adverse effects. Conclusion The anterior QLB and the PENG block provided comparable posthip arthroplasty analgesia for patients subjected to surgeries under spinal anesthesia as evidenced by the comparable pain VAS scores, duration of analgesia, and total 24 h’ morphine consumption with comparable block and opioid safety profiles.

No quadriceps muscle weakness following anterior quadratus lumborum block compared with placebo: a randomized, non-inferiority, blinded, volunteer trial

Background and aimsAnterior quadratus lumborum block is a truncal block, applied in close proximity to the lumbar plexus, potentially causing lower limb weakness. This trial aimed to evaluate whether a...

Comparison of Ultrasound-guided Bilateral Anterior Quadratus Lumborum Block at the Lateral Supra-arcuate Ligament with Conventional Epidural Block in Patients Undergoing Laparoscopic Radical Gastrectomy: A Randomized Controlled Study

Abstract Background: To test the novel ultrasound (US)-guided bilateral anterior quadratus lumborum block (QLBA) at the lateral supra-arcuate ligament (supra-LAL) technique combined with postoperative intravenous analgesia was a viable alternative approach of conventional thoracic epidural analgesia (TEA) for laparoscopic radical gastrectomy (LRG). Methods: Three hundred and four patients scheduled for LRG were randomized 1:1 into QLBA group: receiving a novel pathway of US-guided bilateral QLBA at the supra-LAL before general anesthesia (GA) and patient-controlled intravenous analgesia (PCIA) after surgery, and TEA group: receiving TEA before GA and patient-controlled epidural analgesia following surgery. The difference in procedure time between the treatment groups was set as the primary endpoint. Results: Compared to TEA, procedure time was significantly shorter in the QLBA group (13.19 ± 0.78 vs. 15.65 ± 3.49, P = 0.001). At 5–10 min after block, QLBA group achieved more dermatomes coverage of cold sensory block with both P &lt; 0.001 and less influence on mean artery pressure. Intraoperative consumption of propofol and remifentanil were comparable between the two groups (1116.21 ± 199.76 vs. 1166.45 ± 125.31 ug, P = 0.245 and remifentanil 1.83 ± 0.41 vs. 1.81 ± 0.37 ng, P = 0.988). However, the QLBA group was associated with less intraoperative consumption of norepinephrine and atropine, shorter time to urinary catheter removal, and out-of-bed activity. No significant difference in extubation time, pain scores at rest and exercising across all time points postoperation was observed between two groups. Conclusion: Compared with conventional TEA, the novel technique combined with PCIA was an equivalent effective multimodal analgesic protocol for LRG. There were some advantages of technical simplicity with shorter procedure time, wider anesthetized dermatomes, less influence on intraoperative hemodynamic variables, fewer postoperative adverse events, and improved several sensible parameters of postoperative recovery. Trial Registration: The study was registered in the Chinese Clinical Trial Registry on November 02, 2022 (ChiCTR2200065325).

Meta-analysis of the efficacy of anterior quadratus lumborum block and pudendal nerve block in postoperative analgesia after abdominal surgery

Meta-analysis of the efficacy of anterior quadratus lumborum block and pudendal nerve block in postoperative analgesia after abdominal surgery

Effect of anterior quadratus lumborum block with ropivacaine on the immune response after laparoscopic surgery in colon cancer: a substudy of a randomized clinical trial

BackgroundSurgery induces a temporal change in the immune system, which might be modified by regional anesthesia. Applying a bilateral preoperative anterior quadratus lumborum block has proven to be a safe...

Anterior Quadratus Lumborum Block for Total Laparoscopic Hysterectomy: A Randomized, Double-Blind, Placebo-Controlled Trial.

This study aimed to investigate the perioperative analgesic effects of anterior quadratus lumborum block (QLB) for total laparoscopic hysterectomy (TLH). One hundred patients undergoing TLH were randomized to receive an anterior QLB or placebo before general anesthesia. The primary and secondary outcomes were postoperative sufentanil consumption, intraoperative remifentanil demand, time to first opioid demand, numeric rating scale (NRS) pain scores, heart rate, mean arterial pressure, and complications within 24 h after surgery. No significant intergroup differences were observed in sufentanil consumption within 24 hours after surgery. Remifentanil consumption during surgery was lower in the QLB group than that in the placebo group. At 1 h after surgery, the NRS scores of abdominal visceral pain at rest and during activity were 1.26 and 1.41 points lower than those in the placebo group. In other time points, the differences of abdominal visceral pain were neither statistically significant nor clinically significant (pain difference <1) or both. No significant differences in NRS scores of shoulder pain, abdominal incisional pain and perineal pain were observed between the two groups, no matter at rest or during activity. There were no significant differences in other secondary outcome variables between the two groups. Preoperative bilateral anterior QLB only reduced intraoperative opioid demand and postoperative abdominal visceral pain scores at 1 h after surgery. The clinical significance of anterior QLB in TLH may be limited.

Ultrasound-guided anterior quadratus lumborum block at the L2 level for postsurgical analgesia in patients undergoing laparoscopic gynaecological surgery: a single-centre, randomised, double-blinded trial at a university-affiliated hospital in China

ObjectiveThis study aimed to investigate the analgesic effect of an ultrasound-guided anterior quadratus lumborum block (QLB) at the L2 level on postoperative pain after laparoscopic gynaecological surgery.DesignProspective single-centre randomised double-blind...

Comparison of the effects of subcostal anterior quadratus lumborum block and thoracic paravertebral block in laparoscopic nephrectomy: a randomized study.

Thoracic paravertebral block (TPVB) may provide sufficient postoperative analgesia in laparoscopic nephrectomy (LSN) by ensuring ipsilateral somatic and visceral analgesia. However, there are serious reservations due to the complexity of the technique, and various complications thereof. Subcostal anterior quadratus lumborum block (S-QLB3) may be a safe alternative in LSN procedures. Therefore, this study aimed to compare the postoperative analgesic effects of TPVB and S-QLB3. This prospective, randomized, double-blind study included 60 patients aged 18-70 years who were planned to undergo LSN. The patients were randomly assigned to receive either unilateral ultrasound-guided S-QLB3 or TPVB. The primary outcome was postoperative cumulative 24-h morphine consumption. In addition, numeric rating scale (NRS) scores at rest/activity and the American Pain Society Patient Outcome Questionnaire (APS-POQ-R-TR) scores were also evaluated. While postoperative cumulative 24-h morphine consumption was lower in the TPVB group compared to the other group (mean±SD, 12±3.4 mg vs. 15.4±7.8 mg, P=0.03), NRS pain scores at rest/activity were similar in both groups at all measurement points. Considering the postoperative APS-POQ-R-TR data, only the score related to the pain-daily activity relationship was high in the S-QLB3 group (median [Q1-Q3], 0 [0-1] vs. 2 [0-5], P=0.004), whereas there was no difference between the other scores. In this study, NRS and APS-POQ-R-TR scores were similar in the S-QLB3 and TPVB groups, whereas cumulative morphine consumption was modestly lower in the TPVB group. This suggested that S-QLB3 could be an alternative to TPVB in patients undergoing LSN.

Comparison of ultrasound-guided transversalis fascia plane block and anterior quadratus lumborum block in patients undergoing caesarean delivery: a randomized study

BackgroundCesarean section is becoming increasingly common. Well-managed postoperative analgesia improves patient comfort while encouraging early ambulation and breastfeeding. The analgesic efficacy of transversalis facial plane block (TFPB) vs. anterior quadratus lumborum block (QLB) was compared in this study.MethodsWe analyzed the data of 49 pregnant women (gestation, ≥ 37weeks; age, 18–45years) scheduled for elective cesarean delivery (CD) under general anesthesia. They were randomly divided into TFPB and anterior QLB groups. All blocks were administered bilaterally with 25mL of 0.25% bupivacaine under ultrasound guidance prior to extubation. Postoperative morphine consumption and numerical rating scale (NRS) pain scores (static and dynamic [during coughing]) were recorded at 1, 3, 6, 9, 12, 18, and 24h.ResultsThere was no difference in postoperative morphine consumption between the groups at the third, sixth, and ninth hours, but the anterior QLB group consumed less morphine at the 12th, 18th, and 24th hours. Except for the first hour, resting and dynamic NRS scores were comparable between the groups. The first-hour resting and dynamic NRS scores were lower in the TFPB group (resting NRS, anterior QLB group, median [interquartile range], 2 [2–3] vs. TFPB group, 2 [0–2], p = 0.046; dynamic NRS, anterior QLB group, median [interquartile range], 3 [2–4] vs. TFPB group 2 [0–3], p = 0.001).ConclusionsIn patients undergoing CD, anterior QLB decreased morphine consumption in the late period (9–24h) compared to TFPB, while pain scores were similar between both groups. The reduction in morphine consumption was statistically significant, but not clinically significant.

Effect of interfascial pressure on block success during anterior quadratus lumborum block application: a prospective observational study.

The quadratus lumborum block (QLB) has recently been used frequently for postoperative analgesia after abdominal surgery. The aim of this study was to investigate the effect of pressure changes between the middle thoracolumbar fascia layers to which the anterior QLB (aQLB) is applied at the level of the sensory block. A total of 67 patients planned to undergo laparoscopic cholecystectomy were evaluated in the context of this prospective study. Bilateral aQLBs were administered to all patients, and a peripheral nerve block catheter was placed between the psoas and quadratus lumborum muscles. The correlation of interfascial pressures (IFPs) during block application, 30 min intraoperatively, and 30 min postoperatively with the sensory block level was determined as the primary outcome measure. Secondary outcome measures were the sensory block levels 30 min after block application and 30 min postoperatively; visual analog scale scores 30 min and 6, 12, and 24 h postoperatively; and 24 h tramadol consumption. The preoperatively and intraoperatively measured IFPs differed significantly between the right and left sides (P < 0.05). The preoperative and postoperative block levels also differed significantly between the right and left sides (P < 0.05). The preoperative and postoperative block levels and preoperatively measured IFPs showed a weakly negative correlation (right: r = 0.374; left: r = 0.470). The results of this study show that pressure changes between the fasciae may be effective in aQLB application.

Efficacy of Different Approaches of Quadratus Lumborum Block for Postoperative Analgesia After Cesarean Delivery: A Bayesian Network Meta-analysis of Randomized Controlled Trials.

Various approaches to quadratus lumborum block (QLB) have been found to be an effective analgesic modality after cesarean delivery (CD). However, the evidence for the superiority of any individual approach still needs to be demonstrated. Therefore, we conducted this network meta-analysis to compare and rank the different injection sites for QLB for pain-related outcomes after CD. PubMed, EMBASE, SCOPUS, and the Cochrane Central Registers of Controlled Trials (CENTRAL) were searched for randomized controlled trials (RCTs) evaluating the role of any approach of QLB with placebo/no block for post-CD pain. The primary outcome was parenteral consumption of morphine milligram equivalents in 24 postoperative hours. The secondary end points were early pain scores (4 to 6h), late pain scores (24h), adverse effects, and block-related complications. We used the surface under cumulative ranking probabilities to order approaches. The analysis was performed using Bayesian statistics (random-effects model). Thirteen trials enrolling 890 patients were included. The surface under cumulative ranking probability for parenteral morphine equivalent consumption in 24 hours was the highest (87%) for the lateral approach, followed by the posterior and anterior approaches. The probability of reducing pain scores at all intervals was highest with the anterior approach. The anterior approach also ranked high for postoperative nausea and vomiting reduction, the only consistent reported side effect. The anterior approach QLB had a superior probability for most patient-centric outcomes for patients undergoing CD. The findings should be confirmed through large RCTs.

Efficacy of Anterior Quadratus Lumborum Block and Pain After Total Hip Arthroplasty: A Randomized Controlled Trial

BackgroundAnterior quadratus lumborum block (AQLB) is one of the compartment blocks and has recently attracted attention as a new method of analgesia for postoperative hip surgery analgesia. This study aimed to compare the analgesic efficacy of AQLB in patients undergoing primary total hip arthroplasty (THA). MethodsThere were 120 patients undergoing primary THA under general anesthesia randomly allocated to receive a femoral nerve block (FNB) or an AQLB. The primary outcome was total morphine consumption over the initial 24-hour postoperative period. Secondary outcomes included the pain score evaluation while at rest and during active and passive motion over the 2 days following surgery and the manual muscle testing of the quadriceps femoris. The numerical rating scale (NRS) score was used for evaluating the postoperative pain score. ResultsThere were no significant differences between the 2 groups concerning morphine consumption within 24 hours after surgery (P = .72). The NRS score at rest and passive motion were similar at all-time points (P > .05). However, there was a statistically significant difference in pain reported during the active motion for the FNB group compared to the AQLB (P = .04). No significant differences were found between the 2 groups concerning muscle weakness incidence. ConclusionBoth AQLB and FNB demonstrated adequate efficacy for postoperative analgesia at rest in THA. However, based on our study, whether AQLB is inferior or noninferior to FNB as an analgesic method for THA was inconclusive.

Modified subcostal approach to anterior quadratus lumborum block for managing postoperative pain in patients undergoing open nephrectomy

BackgroundQuadratus lumborum block is a relatively new truncal block and different approaches to this block have been described. With a recent modification to the subcostal approach to the anterior quadratus lumborum block (QLB3), the injection point was moved further cranially and medially, thereby aiming to enhance the spread of the local anesthetic into the thoracic paravertebral space. Although the level of blockade achieved with this modification seems sufficient for open nephrectomy, the modification is still for clinical evaluation. In this retrospective study, we aimed to evaluate the effects of the modified subcostal QLB3 approach on postoperative analgesia.MethodsAll adult patients who received a modified subcostal QLB3 for postoperative analgesia following open nephrectomy between January 2021- 2022 were retrospectively evaluated. Accordingly, total opioid consumption and pain scores during rest/activity within the first 24 h after surgery were evaluated.ResultsA total of 14 patients underwent open nephrectomy were analyzed. Pain scores within the first 6 h postoperatively, particularly the dynamic numeric rating scale (NRS) scores (4–6.5/10), were high. The median (interquartile range) resting and dynamic NRS scores for the first 24 h were 2.75 (1.79) and 3.91 (1.67), respectively. The mean ± standard deviation IV-morphine equivalent dose for the first 24 h was 30.9 ± 10.9 mg.ConclusionsIt was found that the modified subcostal QLB3 did not provide satisfactory analgesia in the early postoperative period. Further randomized studies that extensively investigate the postoperative analgesic efficacy are required to draw a stronger conclusion.