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A randomized controlled trial on analgesic effect of repeated Quadratus Lumborum block versus continuous epidural analgesia following laparoscopic nephrectomy.
BMC Anesthesiology ( IF 2.2 ) Pub Date : 2019-12-05 , DOI: 10.1186/s12871-019-0891-7
Dita Aditianingsih 1 , Pryambodho 1 , Naufal Anasy 1 , Aida Rosita Tantri 1 , Chaidir Arif Mochtar 2
Affiliation  

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.

中文翻译:

腹腔镜肾切除术后重复Quadratus Lumborum阻滞与连续硬膜外镇痛的镇痛效果的随机对照试验。

背景技术作为腹部手术的有效疼痛管理方法,硬膜外镇痛具有副作用,例如感觉异常,低血压,血肿和下肢运动障碍。腰椎方形阻滞(QLB)有可能作为腹部截骨阻滞,但是,其镇痛效果从未与腹腔镜肾切除术中的硬膜外镇痛相提并论。这项前瞻性随机对照研究比较了QLB与硬膜外镇痛技术缓解经腹腔镜腹腔镜肾切除术后术后疼痛的有效性。方法62例患者接受了腹腔镜供体肾切除术,并随机接受QLB(n = 31)或连续硬膜外麻醉(n = 31)。QLB组接受0.25%布比卡因的双侧QLB,硬膜外组接受6 ml / h的0。25%布比卡因用于术中镇痛。术后镇痛时,QLB组在相同的剂量下反复接受双侧QLB,硬膜外组在术后24小时内接受6 ml / h的0.125%布比卡因。主要结局是手术后24小时累积吗啡需求量。次要结果是术后疼痛评分。记录并分析感觉阻滞范围,血流动力学变化,Bromage评分,术后恶心呕吐(PONV),感觉异常和使用导尿管的持续时间。结果QLB组和硬膜外麻醉组术后24小时的吗啡累积需求量和术后疼痛评分相当。QLB的覆盖范围从T9扩展到L2,连续的硬膜外阻滞从T8扩展到L3皮肤。硬膜外组术后24 h测得的平均动脉压(MAP)较低(p = 0.001)。两组的血栓评分,PONV发生率和感觉异常无显着差异。QLB组的导尿管使用时间较短(p <0.001)。结论重复QLB的24小时累积吗啡需求量相似,术后疼痛评分和感觉阻滞相当,术后MAP较高,运动阻滞程度相似,PONV和感觉异常的发生率无差异,并且导尿管使用时间较短经腹腔镜肾切除术后连续硬膜外镇痛。试用注册ClinicalTrial.gov NCT03520205于2018年5月9日进行了追溯注册。两组之间PONV的发生率和感觉异常无显着差异。QLB组的导尿管使用时间较短(p <0.001)。结论重复QLB的24小时累积吗啡需求量相似,术后疼痛评分和感觉阻滞相似,术后MAP较高,运动阻滞程度相似,PONV和感觉异常的发生率无差异,并且导尿管使用时间较短经腹腔镜肾切除术后连续硬膜外镇痛。试用注册ClinicalTrial.gov NCT03520205于2018年5月9日进行了追溯注册。两组之间PONV的发生率和感觉异常无显着差异。QLB组的导尿管使用时间较短(p <0.001)。结论重复QLB的24小时累积吗啡需求量相似,术后疼痛评分和感觉阻滞相当,术后MAP较高,运动阻滞程度相似,PONV和感觉异常的发生率无差异,并且导尿管使用时间较短经腹腔镜肾切除术后连续硬膜外镇痛。试用注册ClinicalTrial.gov NCT03520205于2018年5月9日进行了追溯注册。结论重复QLB的24小时累积吗啡需求量相似,术后疼痛评分和感觉阻滞相当,术后MAP较高,运动阻滞程度相似,PONV和感觉异常的发生率无差异,并且导尿管使用时间较短经腹腔镜肾切除术后连续硬膜外镇痛。试用注册ClinicalTrial.gov NCT03520205于2018年5月9日进行了追溯注册。结论重复QLB的24小时累积吗啡需求量相似,术后疼痛评分和感觉阻滞相似,术后MAP较高,运动阻滞程度相似,PONV和感觉异常的发生率无差异,并且导尿管使用时间较短经腹腔镜肾切除术后连续硬膜外镇痛。试用注册ClinicalTrial.gov NCT03520205于2018年5月9日进行了追溯注册。
更新日期:2019-12-05
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