Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.11.004
Brazilian Journal of Anesthesiology
Clinical Research

Posterior quadratus lumborum versus transversus abdominis plane block for inguinal hernia repair: a prospective randomized controlled study

Bloqueio do plano posterior do quadrado lombar e transverso abdominal para correção de hérnia inguinal: um estudo prospectivo randomizado controlado

Onur Okur, Duygu Karaduman, Zeki Tuncel Tekgul, Noyan Koroglu, Mehmet Yildirim

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Abstract

Background and objectives
We aimed to compare the analgesic effects of both posterior (type 2) Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane Block (TAPB) compared to spinal anesthesia alone for postoperative pain management in inguinal hernia repair.

Methods
This study enrolled 63 patients scheduled for open inguinal hernia repair. The eligibility criteria were undergoing elective unilateral inguinal hernia repair surgery, having an American Society of Anesthesiologists (ASA) status score of 1, 2, or 3, and not suffering from any chronic pain condition. Group S patients received spinal anesthetics and no additional analgesic treatments. Group T patients received TAPB, and Group Q patients received QLB as analgesic technique in addition to spinal anesthetics.

Results
The pain scores at 6 (VAS 6) and 24 hours (VAS 24) were significantly different between groups (p < 0.01). Additionally, the sensory and motor block levels were significantly different between groups (p < 0.05). Multiple comparison tests showed that patients in Group Q had significantly higher sensory and motor block levels (p < 0.01 compared with Group S; p < 0.05 compared with Group T). Opioid consumption was significantly different between Groups Q and S (p < 0.01) after surgery.

Conclusions
Our findings show that both blocks are similarly effective for the management of postoperative pain compared to spinal anesthesia alone for inguinal hernia repair. We found that QLB resulted in a significant cranial spread compared to TAPB. Opioid consumption in QLB was significantly lower than that in controls but similar to that in TAPB.

Keywords

Postoperative pain;  Inguinal hernia;  Quadratus lumborum plane block;  Transversus abdominis plane block;  Spinal anesthesia

Resumo

Justificativa e objetivos: Nosso objetivo foi comparar os efeitos analgésicos do bloqueio do quadrado lombar (QLB) posterior (tipo 2) e do bloqueio do transverso abdominal (TAPB) em comparação com a raquianestesia isolada para o tratamento da dor pós-operatória na correção de hérnia inguinal. Métodos: Este estudo envolveu 63 pacientes programados para correção de hérnia inguinal aberta. Os critérios de elegibilidade foram realizar cirurgia eletiva de hérnia inguinal unilateral, possuir estado físico ASA I, II ou III da American Society of Anesthesiologists (ASA) e não apresentar quadro álgico crônico. Os pacientes do grupo S receberam anestésicos espinhais e nenhum tratamento analgésico adicional. Os pacientes do Grupo T receberam TAPB, e os pacientes do Grupo Q receberam QLB como técnica analgésica, além de raquianestesia. Resultados: Os escores de dor em 6 horas (VAS 6) e 24 horas (VAS 24) foram significativamente diferentes entre os grupos (p <0,01). Além disso, os níveis de bloqueio sensorial e motor foram significativamente diferentes entre os grupos (p <0,05). Os testes de comparação múltipla mostraram que os pacientes do Grupo Q apresentaram níveis de bloqueio sensorial e motor significativamente mais elevados (p <0,01 em comparação com o Grupo S; p <0,05 em comparação com o Grupo T). O consumo de opioides foi significativamente diferente entre os grupos Q e S (p <0,01) após a cirurgia. Conclusões: Nossos achados mostram que ambos os bloqueios são igualmente eficazes para o controle da dor pós-operatória em comparação com a raquianestesia isolada para correção de hérnia inguinal. Descobrimos que o QLB resultou em uma propagação craniana significativa em comparação com o TAPB. O consumo de opioides no QLB foi significativamente menor do que nos controles, mas semelhante ao do TAPB.

Palavras-chave

Dor pós-operatória; Hérnia inguinal; Bloqueio do plano do quadrado lombar; Bloqueio do plano do transverso abdominal; Raquianestesia

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