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      A randomized controlled trial on analgesic effect of repeated Quadratus Lumborum block versus continuous epidural analgesia following laparoscopic nephrectomy

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          Abstract

          Background

          Epidural analgesia as the effective pain management for abdominal surgery has side effects such as paresthesia, hypotension, hematomas, and impaired motoric of lower limbs. The quadratus lumborum block (QLB) has potential as an abdominal truncal block, however, its analgesic efficacy has never been compared to epidural analgesia on laparoscopic nephrectomy. This prospective randomized controlled study compared the effectiveness of QLB with the epidural analgesia technique in relieving postoperative pain following transperitoneal laparoscopic nephrectomy.

          Methods

          Sixty-two patients underwent laparoscopic donor nephrectomy and were randomized to receive QLB ( n = 31) or continuous epidural ( n = 31). The QLB group received bilateral QLB using 0.25% bupivacaine and the epidural group received 6 ml/h of 0.25% bupivacaine for intraoperative analgesia. As postoperative analgesia, the QLB group received repeated bilateral QLB with the same dose and the epidural group received 6 ml/h of 0.125% bupivacaine for 24 h after surgery completion. The primary outcome was the 24-h cumulative morphine requirement after surgery. The secondary outcome was the postoperative pain scores. Sensory block coverage, hemodynamic changes, Bromage score, postoperative nausea-vomiting (PONV), paresthesia, and duration of urinary catheter usage were recorded and analyzed.

          Result

          The 24-h cumulative morphine requirement and pain scores after surgery were comparable between the QLB and epidural groups. The coverage of QLB was extended from T9 to L2 and the continuous epidural block was extended from T8 to L3 dermatomes. The mean arterial pressure (MAP) measured at 24 h after surgery was lower in the epidural group ( p = 0.001). Bromage score, incidence of PONV, and paresthesia were not significantly different between the two groups. Duration of urinary catheter usage was shorter ( p < 0.001) in the QLB group.

          Conclusion

          The repeated QLB had a similar 24-h cumulative morphine requirement, comparable postoperative pain scores and sensory blockade, higher postoperative MAP, a similar degree of motoric block, no difference in the incidence of PONV and paresthesia , and shorter urinary catheter usage, compared to the continuous epidural analgesia following transperitoneal laparoscopic nephrectomy.

          Trial registration

          ClinicalTrial.gov NCT03520205 retrospectively registered on May 9th 2018.

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          Most cited references27

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          Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Pain After Cesarean Delivery: A Randomized Controlled Trial.

          Effective postoperative analgesia after cesarean delivery enhances early recovery, ambulation, and breastfeeding. In a previous study, we established the effectiveness of the quadratus lumborum block in providing pain relief after cesarean delivery compared with patient-controlled analgesia (morphine). In the current study, we hypothesized that this method would be equal to or better than the transversus abdominis plane block with regard to pain relief and its duration of action after cesarean delivery.
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            The Pathway of Injectate Spread With the Transmuscular Quadratus Lumborum Block: A Cadaver Study.

            The spread of injectate resulting from a transmuscular quadratus lumborum (TQL) block and a transverse oblique paramedian (TOP) TQL block has never been examined. The aim of this cadaveric study was to investigate by which pathway the injectate spreads cephalad into the thoracic paravertebral space and which nerves were dyed by the injectate cephalad and caudad to the diaphragm when performing a TQL and a TOP TQL block. We also aimed to investigate whether the thoracic and lumbar sympathetic trunks as well as the lumbar plexus were covered by the injectate.
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              Quadratus Lumborum Block

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                Author and article information

                Contributors
                ditaaditiaa@gmail.com
                pryambodho.pry@icloud.com
                naufal.anasy@gmail.com
                aidatantri@yahoo.com
                chaidir.arif1960@gmail.com
                Journal
                BMC Anesthesiol
                BMC Anesthesiol
                BMC Anesthesiology
                BioMed Central (London )
                1471-2253
                5 December 2019
                5 December 2019
                2019
                : 19
                : 221
                Affiliations
                [1 ]ISNI 0000000120191471, GRID grid.9581.5, Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo General Hospital, , Universitas Indonesia, ; 6th Salemba Raya, DKI Jakarta, 10430 Indonesia
                [2 ]ISNI 0000000120191471, GRID grid.9581.5, Department of Urology, Cipto Mangunkusumo General Hospital, , Universitas Indonesia, ; DKI Jakarta, Indonesia
                Author information
                http://orcid.org/0000-0001-6201-2400
                Article
                891
                10.1186/s12871-019-0891-7
                6894195
                31805855
                6ec5081a-25c8-4111-b281-b921190e12ae
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 17 August 2019
                : 25 November 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100006378, Universitas Indonesia;
                Award ID: 1303/UN2.R3.1/HKP.05.00/2018
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Anesthesiology & Pain management
                epidural analgesia,laparoscopic nephrectomy,postoperative analgesia,patient-controlled analgesia,quadratus lumborum block

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