Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.01.009
Brazilian Journal of Anesthesiology
Clinical Research

Quadratus lumborum block (transmuscular approach) versus transversus abdominis plane block (unilateral subcostal approach) for perioperative analgesia in patients undergoing open nephrectomy: a randomized, double-blinded, controlled trial

Bloqueio do quadrado lombar (abordagem transmuscular) versus bloqueio do plano abdominal transverso (abordagem subcostal unilateral) para analgesia perioperatória em pacientes submetidos à nefrectomia aberta: um estudo randomizado, duplo-cego e controlado

Amany H. Saleh, Mai W. Abdallah, Ashraf M. Mahrous, Norhan A. Ali

Downloads: 0
Views: 124

Abstract

Study objective
Patients undergoing open nephrectomy surgery experience severe perioperative pain, which is primarily due to incision of several muscles. Abdominal wall blocks are known to reduce pain without causing epidural-associated hypotension. We conducted this study to compare unilateral ultrasound-guided transmuscular quadratus lumborum block and posterior transversus abdominis block in combination with general anesthesia alone in terms of intraoperative and postoperative analgesics and hemodynamics and postoperative complications.

Methods
This was a randomized, double-blinded, controlled trial conducted in the operating room. This study included 48 patients aged 20–60 years, with ASAI and II and a body mass index ≤ 30 kg.m-2 who were scheduled for open nephrectomy procedure.The 48 patients scheduled for nephrectomy were randomly allocated into one of the following three groups after induction of general anesthesia: Group A (n = 16) received USG transmuscular QLB; Group B (n = 16) received unilateral USG posterior transversus abdominis plane (TAP) block; and Group C (n = 16; control group) did not receive any blocks. Introperative fentanyl consumption, and hemodynamics (heart rate and mean arterial pressure (MAP)) were recorded after anesthesia induction, at surgical incision, and every 15 min till the end of surgery. Visual Analogue Scale (VAS) was evaluated immediately at 30 min and 1,2,4,6, and 12 hours postoperatively. The time of first analgesic request was also recorded.

Results
Intraoperative fentanyl consumption (μg) was significantly lower in Groups A and B (164.69 ± 27.35 and 190.31 ± 44.48, respectively) than in Group C (347.50 ± 63.64) (p < 0.001). Postoperatively, total pethidine consumption was significantly lower in Groups A and B than in Group C (85.31 ± 6.68, 84.06 ± 4.17 mg, and 152.19 ± 43.43 mg, respectively) (p < 0.001. Time to rescue analgesia was longer in Groups A and B than in Group C (138.75 ± 52.39 min, 202.50 ± 72.25 min, and 37.50 ± 13.42 min, respectively) (p < 0.001). VAS score was significantly lower in Groups A and B than in Group C at 30 min and 1,2,4, and 6 h postoperatively.

Conclusion
Transmuscular quadratus lumborum block and posterior transversus abdominis blocks were effective in providing perioperative analgesia in patients undergoing open nephrectomy. However, quadratus lumborum block provided superior analgesia.

Keywords

Open nephrectomy;  Regional anesthesia;  Visual Analogue Scale;  Post-operative analgesia

Resumo

Objetivo do estudo: Pacientes submetidos à cirurgia de nefrectomia aberta apresentam forte dor perioperatória, que se deve principalmente à incisão de vários músculos. Os bloqueios da parede abdominal são conhecidos por reduzir a dor sem causar hipotensão associada à epidural. Conduzimos este estudo para comparar o bloqueio transmuscular do quadrado lombar guiado por ultrassom unilateral e o bloqueio transverso abdominal posterior em combinação com anestesia geral isolada em termos de analgésicos intra e pós-operatórios e hemodinâmica e complicações pós-operatórias. Métodos: Este foi um ensaio clínico randomizado, duplo-cego e controlado conduzido em sala de cirurgia. Este estudo incluiu 48 pacientes com idades entre 20-60 anos, com ASAI e II e um índice de massa corporal ≤30kg / m2 que foram agendados para procedimento de nefrectomia aberta. Os 48 pacientes agendados para nefrectomia foram alocados aleatoriamente em um dos três grupos a seguir após a indução de anestesia geral: Grupo A (n = 16) recebeu USG QLB transmuscular; Grupo B (n = 16) recebeu bloqueio unilateral do plano transverso abdominal (PTA) da USG; e o Grupo C (n = 16; grupo controle) não recebeu nenhum bloqueio. O consumo de fentanil intraoperatório e a hemodinâmica (frequência cardíaca e pressão arterial média (PAM)) foram registrados após a indução da anestesia, na incisão cirúrgica e a cada 15 minutos até o fim da cirurgia. A Escala Visual Analógica (VAS) foi avaliada imediatamente aos 30 min e 1,2,4,6 e 12 horas de pós-operatório. O horário da primeira solicitação de analgésico também foi registrado. Resultados: O consumo intraoperatório de fentanil (µg) foi significativamente menor nos Grupos A e B (164,69 ± 27,35 e 190,31 ± 44,48, respectivamente) do que no Grupo C (347,50 ± 63,64) (p <0,001). No pós-operatório, o consumo total de petidina foi significativamente menor nos Grupos A e B do que no Grupo C (85,31 ± 6,68,84,06 ± 4,17 mg e 152,19 ± 43,43mg, respectivamente) (p <0,001. O tempo para resgatar a analgesia foi maior nos Grupos A e B no Grupo C (138,75 ± 52,39min, 202,50 ± 72,25min, e 37,50 ± 13,42min, respectivamente) (p <0,001). A pontuação VAS foi significativamente menor nos Grupos A e B do que no Grupo C em 30min e 1,2,4 e 6h de pós-operatório. Conclusão: O bloqueio transmuscular do quadrado lombar e o transverso abdominal posterior foram eficazes no fornecimento de analgesia perioperatória em pacientes submetidos à nefrectomia aberta. No entanto, o bloqueio do quadrado lombar proporcionou analgesia superior.

Palavras-chave

Nefrectomia aberta, anestesia regional, Escala Visual Analógica, analgesia pós-operatória.

References

1 P. Bajaj Postoperative Pain Management: Organisation and Audits Indian J Anaesth., 51 (2007), pp. 441-443

2 E. Chapman, A. Pichel Anaesthesia for nephrectomy BJA Educ., 16 (2016), pp. 98-101

3 K. Abdelsalam, O.W. Mohamdin Ultrasound-guided rectus sheath and transversus abdominis plane blocks for perioperative analgesia in upper abdominal surgery: A randomized controlled study Saudi J Anaesth., 10 (2016), pp. 25-28

4 S. Bhattacharjee, M. Ray, T. Ghose, et al. Analgesic efficacy of transversus abdominis plane block in providing effective perioperative analgesia in patients undergoing total abdominal hysterectomy: A randomized controlled trial J Anaesthesiol Clin Pharmacol., 30 (2014), pp. 391-396

5 K. Abdelsalam, S. Sultan Effectiveness of ultrasound-guided transversus abdominis plane block for intraoperative and postoperative analgesia in kidney transplantation Ain-Shams J Anaesthesiol., 8 (2015), p. 140

6 H. Ueshima, H. Otake, J-A.A. Lin Ultrasound-Guided Quadratus Lumborum Block: An Updated Review of Anatomy and Techniques Biomed Res Int., 2017 (2017), pp. 1-7

7 Y.H. Chan Biostatistics 102: quantitative data--parametric &amp; non-parametric tests Singapore Med J., 44 (2003), pp. 391-396

8 Y.H. Chan Biostatistics 103: qualitative data - tests of independence Singapore Med J., 44 (2003), pp. 498-503

9 A.M. Shafeek, G.A. Gomaa, F.A.A. Elmalek, et al. A Comparative Study between Ultrasound Guided Quadratus Lumborum Block Versus Ultrasound Guided Transversus Abdominis Plane Block in Laporoscopic Bariatric Surgery Egypt J Hosp Med., 70 (2018), pp. 2090-2199

10 H. Elsharkawy, S. Ahuja, S. DeGrande, et al. Subcostal approach to anterior quadratus lumborum block for pain control following open urological procedures J Anesth., 33 (2019), pp. 148-154

11 N.K. Yousef Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Patients Undergoing Total Abdominal Hysterectomy: A Randomized Prospective Controlled Trial Anesth essays Res., 12 (2018), pp. 742-747

12 R. Blanco, T. Ansari, E. Girgis Quadratus lumborum block for postoperative pain after caesarean section Eur J Anaesthesiol., 32 (2015), pp. 812-818

13 C. Warusawitharana, S.H.M.A. Basar, B.L. Jackson, et al. Ultrasound guided continuous transmuscular quadratus lumborum analgesia for open renal surgery: A case series J Clin Anesth., 42 (2017), pp. 100-101

14 D.K. Baidya, S. Maitra, M.K. Arora, et al. Quadratus lumborum block: an effective method of perioperative analgesia in children undergoing pyeloplasty J Clin Anesth., 27 (2015), pp. 694-696

15 G. Öksüz, B. Bilal, Y. Gürkan, et al. Quadratus Lumborum Block Versus Transversus Abdominis Plane Block in Children Undergoing Low Abdominal Surgery Reg Anesth Pain Med., 42 (2017), pp. 674-679

16 G.D. Kumar, N. Gnanasekar, P. Kurhekar, et al. A Comparative Study of Transversus Abdominis Plane Block versus Quadratus Lumborum Block for Postoperative Analgesia following Lower Abdominal Surgeries: A Prospective Double-blinded Study Anesth essays Res., 12 (2018), pp. 919-923
 

605e366ba9539520c7469c54 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections