Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Decreases Persistent Postoperative Pain Severity in Patients Undergoing Both Open and Laparoscopic Nephrectomies-A Randomized Controlled Trial

Michał Borys; Patrycja Szajowska; Mariusz Jednakiewicz; Grzegorz Wita; Tomasz Czarnik; Marcin Mieszkowski; Bułat Tuyakov; Piotr Gałkin; Mansur Rahnama-Hezavah; Mirosław Czuczwar; Paweł Piwowarczyk

doi:10.3390/jcm10163590

Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Decreases Persistent Postoperative Pain Severity in Patients Undergoing Both Open and Laparoscopic Nephrectomies-A Randomized Controlled Trial

J Clin Med. 2021 Aug 15;10(16):3590. doi: 10.3390/jcm10163590.

Authors

Affiliations

¹ Second Department of Anesthesia and Intensive Care, Medical University of Lublin, 20-059 Lublin, Poland.
² Department of Anesthesia and Intensive Care, Frederic Chopin Clinical Provincial Hospital No. 1, 35-310 Rzeszów, Poland.
³ Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, Opole University, 45-040 Opole, Poland.
⁴ Department of Anesthesiology and Intensive Care, Regional Specialist Teaching Hospital, 10-719 Olsztyn, Poland.
⁵ Department of Anesthesiology and Intensive Care, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Al. Warszawska 30, 10-082 Olsztyn, Poland.
⁶ Department of Anesthesia and Intensive Care, Jedrzej Sniadecki Hospital, 15-027 Białystok, Poland.
⁷ Chair and Department of Dental Surgery, Medical University of Lublin, 20-059 Lublin, Poland.

Abstract

Background: New regional techniques can improve pain management after nephrectomy.

Methods: This study was a randomized controlled trial conducted at two teaching hospitals. Patients undergoing elective open and laparoscopic nephrectomy were eligible to participate in the trial. A total of 100 patients were divided into a quadratus lumborum block (QLB) group (50 patients) and a control (CON) group (50 patients). At the end of surgery, but while still under general anesthesia, unilateral QLB with ropivacaine was performed on the side of nephrectomy for patients in the QLB group. The main measured outcome of this study was oxycodone consumption via a patient-controlled anesthesia (PCA) pump during the first 24 h following surgery; other measured outcomes included postoperative pain intensity assessment, patient satisfaction with pain management, and persistent pain evaluation.

Results: Patients undergoing QLB needed less oxycodone than those in the CON group (34.5 mg (interquartile range 23 to 40 mg) vs. 47.5 mg (35-50 mg); p < 0.001). No difference between the groups was seen in postoperative pain intensity measured on the visual analog scale, except for the evaluation at hour 2, which was in favor of the QLB group (p = 0.03). Patients who received QLB were more satisfied with postoperative pain management than the CON group. Persistent postoperative pain was assessed with the Neuropathic Pain Symptom Inventory (NPSI) at months 1, 3, and 6, and was found to be significantly lower in the QLB group at each evaluation (p < 0.001). We also analyzed the impact of the surgery type on persistent pain severity, which was significantly lower after laparoscopic procedures than open procedures at months 1, 3, and 6.

Conclusions: QLB reduces oxycodone consumption in patients undergoing open and laparoscopic nephrectomy and decreases persistent pain severity months after hospital discharge.

Keywords: nephrectomy; neuropathic pain symptom inventory; patient-controlled analgesia; persistent postoperative pain; quadratus lumborum block.