Quadratus Lumborum Block Research Articles

Effect of dexmedetomidine as an adjuvant to bupivacaine in bilateral posterior quadratus lumborum block for postoperative analgesia after cesarean delivery: A prospective randomized double-blinded study

Effect of dexmedetomidine as an adjuvant to bupivacaine in bilateral posterior quadratus lumborum block for postoperative analgesia after cesarean delivery: A prospective randomized double-blinded study

COMPARISON OF ULTRASOUND-GUIDED LUMBAR ERECTOR SPINAE PLANE BLOCK AND TRANSMUSCULAR QUADRATUS LUMBORUM BLOCK FOR POST-OPERATIVE ANALGESIA IN TOTAL HIP REPLACEMENT SURGERIES: A PROSPECTIVE RANDOMIZED STUDY

Objectives: The objective of the study is to compare the efficacy of ultrasound-guided lumbar erector spinae plane block (ESPB) and transmuscular quadratus lumborum block (QLB) in providing post-operative analgesia for patients undergoing total hip replacement (THR) surgeries. Methods: This prospective, randomized, double-blind study compared the efficacy of ultrasound-guided lumbar ESPB and transmuscular QLB (QLB-t) for post-operative analgesia in THR surgeries. Ninety patients were randomized into three groups: ESPB, QLB, and a control group. Primary outcomes included the duration of analgesia, measured by numeric rating scale scores, and secondary outcomes assessed total analgesic consumption and the incidence of post-operative nausea and vomiting (PONV) within 24 h. For statistical purposes, p<0.05 was taken as statistically significant. Results: This study compared lumbar ESPB and QLB for post-operative analgesia in THR surgeries. At the 1st h, pain scores were significantly lower in the ESPB (1.30) and QLB (1.05) groups compared to the control group (2.15) (p<0.001). Tramadol consumption in the first 12 h was significantly lower in the ESPB (52.3 mg) and QLB (50.1 mg) groups compared to the control group (135.20 mg) (p<0.001). PONV was absent in 60% of ESPB and 63% of QLB patients, compared to only 33% in the control group (p=0.038). Conclusion: Lumbar-ESPB and QLB-t blocks effectively reduce post-operative pain and analgesic requirements in THR surgeries, showing comparable benefits. Both techniques also lower the incidence of PONV.

Dermatomal spread in lateral quadratus lumborum blocks versus transversus abdominus plane blocks after laparoscopic colorectal surgery: a randomized clinical trial

IntroductionPostoperative pain after laparoscopic abdominal surgery remains complex. While lateral quadratus lumborum (QL) block and transversus abdominus plane (TAP) block are similar techniques, no studies have examined if one technique...

Comparative analysis of the effectiveness of quadratus lumborum and transversus abdominis muscle blocks for postoperative pain relief during laparoscopic robot-assisted total hysterectomy.

The purpose of this study was to compare and evaluate the analgesic effectiveness of quadratus lumborum block (QLB) and transversus abdominis plane bloc block (TAPB) after laparoscopic robot-assisted total hysterectomy. Materials and methods. A prospective study of female patients (n=101), with physical status ASA I-II, who underwent laparoscopic robot-assisted total hysterectomy under multicomponent general anesthesia. In random order, patients were randomized into three groups: the first group (CON, n=40) - control, where no blocks were performed, the second group (TAPB, n=30) - a blockade of the transverse abdominis muscle, the third group (QLB, n= 31) – blockade of the quadratus lumborum muscle was performed. After surgery, pain was assessed using a 10-point digital visual analogue scale, and postoperative nausea and vomiting were assessed. (PONV) Average arterial pressure and heart rate were recorded. Additionally, the next morning, a survey was conducted to assess the well-being and satisfaction of patients. Results. There were no differences between the groups in terms of demographic characteristics, duration of surgery, and analgesic consumption during the intraoperative period. The severity of postoperative pain was higher (p<0.05) in the control group than in the blockade groups. Both block groups demonstrated lower pain scores at all time points assessed. The latest need for analgesics was in the QLB group. Mean arterial pressure (MAP) values differed only in the first 2 hours after surgery between the CON and TAPB groups (p<0.05). PONV one hour after surgery was more observed in the control group and less in the QLB group (p<0.05). According to the results of a survey conducted on the day after surgery, the number of patients satisfied with the anesthesia and assistance provided in the recovery room in the groups with blockade (TAPB, QLB) was 2.1-5.3% higher (p>0.05). More patients from the QLB group (p<0.05) noted very good and good health, and most patients (p<0.05) from the CON and TAPB group noted satisfactory health. Conclusion. The use of interfascial blocks for postoperative pain relief (TAPB, QLB) after laparoscopic robot-assisted hysterectomy improves the quality of pain relief and the well-being of patients. Benefits of QLB include better pain relief, reduced incidence of PONV, and greater patient satisfaction. TARP has shown equally good results, and this method is easier to perform.

Effectiveness of ultrasound-guided ilioinguinal and iliohypogastric nerve block in pediatric inguinal hernia surgery: a systematic review and meta-analysis of randomized controlled trials

Aim: To evaluate the efficacy of ultrasound-guided ilioinguinal and iliohypogastric nerve block (IIHB) in children undergoing surgery for inguinal hernias.Material and methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched to January 4, 2024. For continuous data, the effect sizes were presented as weighted mean differences (WMDs), and for categorical data, they were reported as relative ratios (RR), each accompanied by 95% confidence intervals (CIs).Results: IIHB demonstrated a longer duration before the need for the first analgesic compared to transverse abdominis plane (TAP), caudal epidural block (CEB), and pre-incisional wound infiltration (PWI), but a shorter duration than quadratus lumborum block (QLB). The IIHB group had a higher probability of requiring rescue analgesics compared to other blocks or PWI (RR: 1.69, 95% CI: 1.25 to 2.28, p=0.001). Higher FLACC scores were noted at 12 hours for the IIHB group (WMD:0.50, 95% CI: 0.13 to 0.86, p=0.008). IIHB required more intraoperative fentanyl compared to controls (RR: 2.14, 95% CI:1.17 to 3.92, p=0.014).Conclusion: While IIHB may have some benefits, it does not appear to be more effective overall in managing postoperative pain in pediatric inguinal hernia surgery patients compared to other blocks or PWI.

Ultrasound-guided quadratus lumborum block with 0.5 mL of 0.2% bupivacaine/kg is a valuable perioperative analgesic adjunct for cats undergoing ovariectomy.

To assess the perioperative analgesic effects of bilateral ultrasound (US)-guided quadratus lumborum block (QLB) using low-volume (LV) or high-volume (HV) bupivacaine, compared to a control group, in cats undergoing ovariectomy. 48 healthy female cats. Cats were sedated with IM dexmedetomidine (5 µg/kg), ketamine (1 mg/kg), and methadone (0.2 mg/kg) followed by IV propofol induction and isoflurane maintenance. Cats were randomly assigned to 3 groups of 16 patients each: QLB-LV group (0.3 mL/kg/side), QLB-HV group (0.5 mL/kg/side), and control group (no QLB). Bilateral, in-plane, US-guided QLB was performed with lateral approach at the L2 transverse process with bupivacaine 0.2%. Physiological variables were recorded intraoperatively by a masked investigator. If intraoperative nociception occurred, fentanyl (1 µg/kg) was administered IV. Rescue postoperative analgesia (buprenorphine, 0.2 mg/kg) was administered in case of a Feline Grimace Scale score ≥ 4 after a 4-hour evaluation period. In the control group, heart rate (HR) was higher than the QLB-LV group during the first ovarian manipulation (P < .001) and higher than the QLB-HV group during both ovarian manipulations (P < .001 and P = .006). The need for intraoperative rescue analgesia and postoperative pain scores were significantly higher in the QLB-LV (P = .005 and P = .047) and control (P < .001 and P < .001) groups compared to the QLB-HV group. Buprenorphine was administered once in the control group. No clinical signs of bupivacaine toxicity or QLB complications were observed. Bilateral US-guided QLB-HV may effectively provide perioperative analgesia in feline patients undergoing ovariectomy.

Regional analgesia techniques following nephrectomy: a systematic review and network meta-analysis.

This network meta-analysis (NMA) was performed to assess the relative efficacy and safety of various regional analgesic techniques used in patients undergoing partial nephrectomy or nephrectomy. Randomized controlled trials (RCTs) evaluating different regional analgesia techniques in patients underwent partial nephrectomy or nephrectomy were retrieved from databases, including PubMed, Embase, Web of Science, and the Cochrane Library, from inception to January 2024. The NMA was made by using Stata 15.1 softwares. The certainty of evidence was assessed by using CINeMA. We included 27 trials with 1852 patients and 14 techniques. Postoperative resting pain scores within 24 hours were decreased by erector spinae plane block (ESPB), thoracic paravertebral block (TPVB), intrathecal morphine (IM), retrolaminar block (RLB). Postoperative movement pain scores within 24 hours were decreased by ESPB, TPVB, lateral quadratus lumborum block (QLB-L), transversus abdominis plane block. Postoperative opiates consumption within 24 hours were decreased most by QLB-L, followed by transmuscular QLB (QLB-TM), TPVB, and IM. Postoperative nausea and vomiting (PONV) were decreased by RLB, anterior QLB approach at the lateral supra-arcuate ligament (QLB-LSAL). Length of hospital stay were decreased by TPVB, ESPB. This available evidence suggests that ESPB and TPVB are more likely to reduce pain scores within 24 hours and shorten the length of hospital stay. QLB-L and QLB-TM are more likely to reduce the cumulative opiates consumption within 24 hours. RLB and QLB-LSAL are more likely to decrease the incidence of PONV. The wound infiltration (WI), intraperitoneal instillation (IPI), and WI+IPI are less likely to be effective.

Efficacy of Quadratus Lumborum Block Compared to Paravertebral Block on Pediatric Patients Undergoing Abdominal Surgery

Background: Abdominal surgery is a major procedure associated with severe postoperative pain in pediatric patients. Quadratus lumborum block (QLB) is considered an effective pain control in such cases. Paraverterbral block (PVB) is another option for postoperative pain management. The aim of this study was to compare the effectiveness of quadratus lumborum block with paravertebral block. Methods: This single-blind randomized controlled trial included 22 pediatric patients who underwent abdominal surgery at Sanglah Hospital, Denpasar between August – October 2022. Research subjects were divided into 2 treatment groups; group A consisted of general anesthesia combined with quadratus lumborum block and group B consisted of general anesthesia combined with paravertebral block. Duration of analgesia was recorded based on the time to analgesic rescue, FLACC pain scale at 0, 2, 4, 6, 12 and 24 hours and total opioid consumption 24 hours after surgery. Statistical analyses were performed using SPSS. Results: Eleven patients received QLB and PVB respectively. There was a significant difference in mean analgesia duration of 1287 ± 129.69 minutes compared to 750 ± 122.22 minutes (p &lt; 0.001) (CI 95%: 425.18 – 649.36), median FLACC pain scale at 12 (1 (IQR 2) vs 4 (IQR 1)) and 24 hours postoperative (1 (IQR 2) vs 3 (IQR 1)) between QLB and PVB (p &lt; 0.001 and p &lt; 0.007). Mean 24-hour postoperative opioid consumption was significantly lower in the QLB compared to the PVB. Conclusion: QLB has better effectiveness than PVB in pediatrics undergoing abdominal surgery.

Comparative efficacy of erector spinae plane and quadratus lumborum blocks in managing postoperative pain for total abdominal hysterectomy: A randomized controlled trial.

Effective postoperative pain management after total abdominal hysterectomy is crucial for patient recovery and satisfaction. This study compared the efficacy of the erector spinae plane block (ESPB) and quadratus lumborum block (QLB) in reducing postoperative opioid consumption and pain in patients with total abdominal hysterectomy. In this prospective, randomized controlled trial, 90 patients undergoing total abdominal hysterectomy were divided into 3 groups: ESPB, QLB, and control. The primary outcome was postoperative opioid consumption. Secondary outcomes included pain scores assessed by the visual analog scale at predetermined times and the incidence of postoperative nausea and vomiting. Statistical significance was determined using analysis of variance, the Mann-Whitney U test, and the Kruskal-Wallis test. The ESPB and QLB groups showed a significant reduction in postoperative opioid consumption compared with the control group (P < .001 for both comparisons). Pain scores were significantly lower in the ESPB and QLB groups than in the control group at 2, 6, and 24 hours postoperatively (P < .001 at each time point). The incidence of postoperative nausea and vomiting was lower in the ESPB and QLB groups than that in the control group; however, this difference was not statistically significant (P = .029). No significant differences were observed in opioid consumption or pain scores between the 2 groups. Both the erector spinae plane and quadratus lumborum blocks effectively reduced postoperative opioid consumption and pain in patients with total abdominal hysterectomy. These techniques offer a promising approach for postoperative pain management, potentially reducing the need for opioids.

Comparison of intrathecal fentanyl as an adjunct in spinal anaesthesia to ultrasound-guided quadratus lumborum block as an effective postoperative analgesia for Caesarean section surgery.

Postoperative pain in patients, if dealt with inadequately, has been a significant cause of morbidity. The present study compared the postoperative analgesic efficacy of intrathecal fentanyl and ultrasound-guided quadratus lumborum block following Caesarean surgery. A prospective randomised controlled study was planned for parturients who underwent Caesarean surgery under spinal anaesthesia. Patients received bupivacaine (10mg) and 25µg of intrathecal fentanyl in the spinal anaesthesia (group intrathecal fentanyl, n = 30) or 20mL of 0.375% ropivacaine bilateral quadratus lumborum block (group quadratus lumborum; n = 30) after surgery. The visual analogue scale score, quality of recovery-15 score and incidence of ill effects were recorded. The postoperative haemodynamic parameters were comparable between the two groups. The visual analogue scale score at different time intervals decreased after the quadratus lumborum block (p < 0.05). The mean global quality of recovery score was better in the quadratus lumborum group (p < 0.001). In the quadratus lumborum group, the mean time to first ambulation was lower than that in the intrathecal fentanyl group (p < 0.05). The requirement for first-rescue analgesia was earlier in the intrathecal fentanyl group (4.67 ± 0.72) than in the quadratus lumborum group (4.92 ± 0.88). Intrathecal fentanyl and quadratus lumborum block had effective postoperative analgesic effects on Caesarean surgery patients. However, the quadratus lumborum block group exhibited better analgesia and early ambulation than the intrathecal fentanyl group, with an improved quality of recovery.

Sensory assessment of intramuscular quadratus lumborum block at the L2 level in open inguinal hernia repair patients

BackgroundThe effectiveness of the quadratus lumborum block (QLB) for postoperative pain management depends on the injection pathway used. There is limited research on the block area produced by intramuscular injection of local anesthesia in the quadratus lumborum muscle. This study aimed to determine the cutaneous sensory blockade area produced by an intramuscular quadratus lumborum block (QLBi) at the L2 level.MethodsTwenty patients aged 18–60 years with ASA grade I-II and a BMI of 18–30 kg/m2 who were scheduled for open inguinal hernia repair with mesh underwent ultrasound-guided QLBi injection of 20 ml of 0.5% ropivacaine. The cutaneous sensory blockade area was measured by applying a cold stimulus 1 h after the block and then measured every hour after surgery until the sensation returned to normal. The duration of a blockade is defined as the time it takes for all affected areas to fully regain normal sensation following a blockade. Pain scores (numeric rating scale, NRS) were recorded at 2, 4, 8, 12, and 24 h after surgery. Adverse reactions to QLBi were recorded 24 h after surgery.ResultsAll 20 patients had reduced or lost cold sensation areas. The greatest extent of cold sensation reduction occurred at T7 (10%), and the least amount of cold sensation reduction occurred at L3 (10%). The block level covered T8 (20%), T9 (30%), T10 (45%), T11 (90%), T12 (95%), L1 (100%), and L2 (15%). Eighteen patients experienced areas of sensory loss, with the highest range at T11 and the lowest at L2. The duration of the blockade was 8.9 ± 3.8 h, with a maximum of 24 h and a minimum of 5 h. One patient experienced quadriceps weakness after surgery.ConclusionQuadratus lumborum block of intramuscular pathway can produce effective cutaneous sensory blockade, which can be used for postoperative analgesia of indirect inguinal hernia operation, and may also be beneficial to analgesia of other lower abdominal operations. However, the best method needs further confirmation to determine specific anesthesia methods for various operations.Chinese clinical trial registryJune 2, 2018; ChiCTR1800016457.

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.

Comparison of pericapsular nerve group and lateral quadratus lumborum blocks on cumulative opioid consumption after primary total hip arthroplasty: a randomized controlled trial

IntroductionBoth the quadratus lumborum block (QLB) and the pericapsular nerve group (PENG) block provide effective postoperative analgesia after hip surgery while minimizing the impact on motor function. This study aimed...

Is pericapsular nerve group block superior to other regional analgesia techniques following total hip arthroplasty? a systematic review and network meta-analysis

BackgroundA systematic review and network meta-analysis (NMA) to compare the safety and efficacy of pericapsular nerve group block (PENGB) with other regional analgesia techniques in patients undergoing total hip arthroplasty (THA).MethodsWe searched PubMed, Embase, Web of Science, and the Cochrane Library for relevant research from inception to May, 2024. Randomized controlled trials (RCTs) comparing PENGB with other regional analgesia techniques in patients undergoing THA were included. The primary outcome was resting pain scores at 6 h after surgery. The NMA was made by using Stata 15.1 software. Potential risk of bias was assessed by using CINeMA. Sensitivity and subgroup analyses were performed on the primary outcome.ResultsA total of 11 RCTs including 766 patients were eligible for inclusion. For postoperative resting and movement pain scores within 24 h analysis, PENGB + periarticular local anesthetic infiltration (PLAI) was found to be significantly more effective than other treatments and its Surface under the cumulative ranking curve (SUCRA) was the lowest. Moreover, PENGB + PLAI was ranked the best in reducing opioid consumption within 24 h and the length of hospital stay. PENGB was found to have significantly lower incidence of quadriceps motor block and postoperative nausea and vomiting (PONV).ConclusionsPENGB is more likely to reduce the incidence of quadriceps motor block and PONV in patients undergoing THA, but PENGB + PLAI is superior to other regional analgesia techniques (PLAI, PENGB, fascia iliaca compartment block, and quadratus lumborum block) in improving postoperative pain and shortening the length of hospital stay.Trial registration numberCRD42024538421.

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).

Automatic Segmentation of Ultrasound-Guided Quadratus Lumborum Blocks Based on Artificial Intelligence.

Ultrasound-guided quadratus lumborum block (QLB) technology has become a widely used perioperative analgesia method during abdominal and pelvic surgeries. Due to the anatomical complexity and individual variability of the quadratus lumborum muscle (QLM) on ultrasound images, nerve blocks heavily rely on anesthesiologist experience. Therefore, using artificial intelligence (AI) to identify different tissue regions in ultrasound images is crucial. In our study, we retrospectively collected 112 patients (3162 images) and developed a deep learning model named Q-VUM, which is a U-shaped network based on the Visual Geometry Group 16 (VGG16) network. Q-VUM precisely segments various tissues, including the QLM, the external oblique muscle, the internal oblique muscle, the transversus abdominis muscle (collectively referred to as the EIT), and the bones. Furthermore, we evaluated Q-VUM. Our model demonstrated robust performance, achieving mean intersection over union (mIoU), mean pixel accuracy, dice coefficient, and accuracy values of 0.734, 0.829, 0.841, and 0.944, respectively. The IoU, recall, precision, and dice coefficient achieved for the QLM were 0.711, 0.813, 0.850, and 0.831, respectively. Additionally, the Q-VUM predictions showed that 85% of the pixels in the blocked area fell within the actual blocked area. Finally, our model exhibited stronger segmentation performance than did the common deep learning segmentation networks (0.734 vs. 0.720 and 0.720, respectively). In summary, we proposed a model named Q-VUM that can accurately identify the anatomical structure of the quadratus lumborum in real time. This model aids anesthesiologists in precisely locating the nerve block site, thereby reducing potential complications and enhancing the effectiveness of nerve block procedures.

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).

Comparative study between lateral versus latero-ventral quadratus lumborum block for perioperative analgesia in canine laparoscopic ovariectomy

ObjectiveTo compare the perioperative analgesic effect of lateral versus latero-ventral quadratus lumborum block (QLB) in dogs undergoing laparoscopic ovariectomy. Study designRandomized, blinded clinical study. AnimalsA total of 15 client-owned female dogs undergoing laparoscopic ovariectomy. MethodsAnimals were randomly assigned to receive a bilateral QLB, performed with 0.3 mL kg–1 ropivacaine 0.5%, either with lateral (group LQLB, n = 7) or latero-ventral approach (group LVQLB, n = 7). Dogs were premedicated intramuscularly with methadone 0.2 mg kg–1 and dexmedetomidine 3 μg kg–1. General anaesthesia was induced intravenously (IV) with propofol and maintained with isoflurane. Cardiovascular and respiratory variables were continuously monitored and recorded every 5 minutes during surgery. Fentanyl 3 μg kg–1 was administered IV if there was a 20% increase in heart rate and/or mean arterial pressure from previous values recorded 5 minutes before. Meloxicam 0.2 mg kg–1 was administered IV to all dogs during recovery. The short-form of the Glasgow Composite Pain Scale was used hourly for 8 hours post-QLB. Methadone 0.2 mg kg–1 was administered IV when pain score was ≥ 6/24. A chi-square test compared the number of dogs requiring intraoperative rescue fentanyl. A Friedman test with a Dunn’s post hoc was used to evaluate the trend in postoperative pain scores within each group, and a Mann–Whitney U test compared scores between the groups at each time point; p < 0.05. ResultsSignificantly fewer dogs required intraoperative rescue fentanyl in group LQLB than in group LVQLB. No dog required postoperative rescue methadone, and there were no significant differences in pain scores. Conclusions and clinical relevanceBilateral QLB performed with lateral approach reduced the number of dogs requiring intraoperative rescue analgesia in comparison with the latero-ventral approach. No differences were detected postoperatively, possibly owing to the confounding effects of methadone, dexmedetomidine and meloxicam.

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).

Pain management after laparoscopic cholecystectomy: A systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations.

Laparoscopic cholecystectomy can be associated with significant postoperative pain that is difficult to treat. We aimed to evaluate the available literature and develop updated recommendations for optimal pain management after laparoscopic cholecystectomy. A systematic review was performed using the procedure-specific postoperative pain management (PROSPECT) methodology. Randomised controlled trials and systematic reviews published in the English language from August 2017 to December 2022 assessing postoperative pain after laparoscopic cholecystectomy using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane Databases. From 589 full text articles, 157 randomised controlled trials and 31 systematic reviews met the inclusion criteria. Paracetamol combined with NSAIDs or cyclo-oxygenase-2 inhibitors should be given either pre-operatively or intra-operatively, unless contraindicated. In addition, intra-operative intravenous (i.v.) dexamethasone, port-site wound infiltration or intraperitoneal local anaesthetic instillation are recommended, with opioids used for rescue analgesia. As a second-line regional technique, the erector spinae plane block or transversus abdominis plane block may be reserved for patients with a heightened risk of postoperative pain. Three-port laparoscopy, a low-pressure pneumoperitoneum, umbilical port extraction, active aspiration of the pneumoperitoneum and saline irrigation are recommended technical aspects of the operative procedure. The following interventions are not recommended due to limited or no evidence on improved pain scores: single port or mini-port techniques, routine drainage, low flow insufflation, natural orifice transluminal endoscopic surgery (NOTES), infra-umbilical incision, i.v. clonidine, nefopam and regional techniques such as quadratus lumborum block or rectus sheath block. Several interventions provided better pain scores but are not recommended due to risk of side effects: spinal or epidural anaesthesia, gabapentinoids, i.v. lidocaine, i.v. ketamine and i.v. dexmedetomidine.