Comparative Study between Ultrasound-Guided Quadratus Lumborum Block Type 2 Versus Lumbar Epidural Analgesia as a Perioperative Analgesic Technique for Pelvic Cancer Surgeries

Mohammad Elwakil; John Tharwat; Dina Abbas; Mohammad Elwaseef; Sameeh Elgendy

doi:10.3889/oamjms.2022.10416

Authors

Mohammad Elwakil Department of Anesthesia and Pain Therapy, National Cancer Institute, Cairo University, Cairo, Egypt
John Tharwat Department of Anesthesia and Pain Therapy, National Cancer Institute, Cairo University, Cairo, Egypt
Dina Abbas Department of Anesthesia and Pain Therapy, National Cancer Institute, Cairo University, Cairo, Egypt
Mohammad Elwaseef Department of Anesthesia and Pain Therapy, National Cancer Institute, Cairo University, Cairo, Egypt
Sameeh Elgendy Department of Anesthesia and Pain Therapy, National Cancer Institute, Cairo University, Cairo, Egypt

DOI:

https://doi.org/10.3889/oamjms.2022.10416

Keywords:

Quadratus lumborum block, Pelvic cancer, Ultrasound guided, Analgesic

Abstract

Background: The effect of the quadratus lumborum block (QLB) is believed to result from a spread of LA from its lumbar deposition cranially into the thoracic paravertebral space.The aim of this study is to compare the analgesic efficacy of an Ultrasound-guided quadrates lumborum type II block versus lumbar epidural analgesia or conventional analgesia after pelvic cancer surgeries regarding intraoperative fentanyl consumption, postoperative pain scores and morphine consumption in the first 24 hours.
Methods: This study was conducted on 90 patients of American Society of Anesthesia (ASA) physical status II scheduled for elective pelvic cancer operations. Patients were randomized into three equal groups of 30 patients: Group Q: received bilateral QLB by 20ml of 0.25% bupivacaine in each side, Group E: received continuous lumbar epidural block analgesia ((0.125 % bupivacaine at infusion rate of 6ml/hour for 24 hours). Group C (Control group): were transferred to operation room without further intervention.
Results: End tidal sevoflurane was significantly decreased in group Q than group C and in group E than group C at all time measurements. VAS at 0.5, 1, 8. 16 and 24 hours was significantly increased in group C than Group Q and group E. Time to first rescue dose of morphine was significantly increased in Group E than Group Q (P1 <0.001) and was significantly decreased in group C than Group Q (P2 <0.001) and was significantly decreased in group C than Group E (P3 <0.001). Total dose of morphine in 1st 24 hours was significantly increased at group C than group Q and group E (P <0.001) but there was an insignificant difference between Group Q and E.
Conclusion: When compared to the control group, QLB and epidural block resulted in decreased VAS, intraoperative sevoflurane and fentanyl use and postoperative morphine consumption with a greater level of patient satisfaction. Epidural block, on the other hand, resulted in less intraoperative sevoflurane usage than QLB.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Bonnet F, Marret E. Postoperative pain management and outcome after surgery. Best Pract Res Clin Anaesthesiol. 2007;21(1):99-107. https://doi.org/10.1016/j.bpa.2006.12.007 PMid:17489222 DOI: https://doi.org/10.1016/j.bpa.2006.12.007

Carney J, Finnerty O, Rauf J, Bergin D, Laffey JG, Mc Donnell JG. Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks. Anaesthesia. 2011;66(11):1023-30. https://doi.org/10.1111/j.1365-2044.2011.06855.x PMid:21851346 DOI: https://doi.org/10.1111/j.1365-2044.2011.06855.x

Finnerty O, Carney J, McDonnell JG. Trunk blocks for abdominal surgery. Anaesthesia. 2010;65 Suppl 1:76-83. https://doi.org/10.1111/j.1365-2044.2009.06203.x PMid:20377549 DOI: https://doi.org/10.1111/j.1365-2044.2009.06203.x

Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005;94(1):7-17. https://doi.org/10.1093/bja/aei002 PMid:15277302 DOI: https://doi.org/10.1093/bja/aei002

Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol. 2013;29(4):550-2. https://doi.org/10.4103/0970-9185.119148 PMid:24249997 DOI: https://doi.org/10.4103/0970-9185.119148

Sauter A, Ullensvang K, Bendtsen T, Børglum J. The “shamrock method” a new and promising technique for ultrasound guided lumbar plexus block. Br J Anaesth. 2013;111:9814. https://doi.org/10.1093/bja/el_9814 DOI: https://doi.org/10.1093/bja/el_9814

Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7(1):89-91. https://doi.org/10.1016/0952-8180(94)00001-k PMid:7772368 DOI: https://doi.org/10.1016/0952-8180(94)00001-K

Hudak PL, Wright JG. The characteristics of patient satisfaction measures. Spine (Phila Pa 1976). 2000;25(24):3167-77. https://doi.org/10.1097/00007632-200012150-00012 PMid:11124733 DOI: https://doi.org/10.1097/00007632-200012150-00012

Kumar GD, Gnanasekar N, Kurhekar P, Prasad TK. 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. 2018;12(4):919-23. https://doi.org/10.4103/aer.AER_158_18 PMid:30662131 DOI: https://doi.org/10.4103/aer.AER_158_18

Srivastava D, Verma R, Singh T, Verma A, Chandra A, Sahu S, et al. Ultrasound-guided anterior quadratus lumborum block for postoperative pain after laparoscopic pyeloplasty: A randomized controlled trial. Anaesth Essays Res. 2020;14(2):233-8. https://doi.org/10.4103/aer.AER_45_20 PMid:33487821 DOI: https://doi.org/10.4103/aer.AER_45_20

Jin Z, Liu J, Li R, Gan TJ, He Y, Lin J. Single injection quadratus lumborum block for postoperative analgesia in adult surgical population: A systematic review and meta-analysis. J Clin Anesth. 2020;62:109715. https://doi.org/10.1016/j.jclinane.2020.109715 PMid:31968297 DOI: https://doi.org/10.1016/j.jclinane.2020.109715

Sindwani G, Sahu S, Suri A, Sureka S, Thomas M. Efficacy of ultrasound guided quadratus lumborum block as postoperative analgesia in renal transplantation recipients: A randomised double blind clinical study. Indian J Anaesth. 2020;64(7):605-10. https://doi.org/10.4103/ija.IJA_21_20 PMid:32792737 DOI: https://doi.org/10.4103/ija.IJA_21_20

Hansen C, Dam M, Nielsen MV, Tanggaard KB, Poulsen TD, Bendtsen TF, et al. Transmuscular quadratus lumborum block for total laparoscopic hysterectomy: A double-blind, randomized, placebo-controlled trial. Reg Anesth Pain Med. 2021;46(1):25-30. https://doi.org/10.1136/rapm-2020-101931 PMid:33082286 DOI: https://doi.org/10.1136/rapm-2020-101931

Aoyama Y, Sakura S, Abe S, Wada M, Saito Y. Analgesic effects and distribution of cutaneous sensory blockade of quadratus lumborum block Type 2 and posterior transversus abdominis plane block: An observational comparative study. Korean J Anesthesiol. 2020;73(4):326-33. https://doi.org/10.4097/kja.19404 PMid:32008278 DOI: https://doi.org/10.4097/kja.19404

Dam M, Hansen C, Poulsen TD, Azawi NH, Laier GH, Wolmarans M, et al. Transmuscular quadratus lumborum block reduces opioid consumption and prolongs time to first opioid demand after laparoscopic nephrectomy. Reg Anesth Pain Med. 2021;46(1):18-24. https://doi.org/10.1136/rapm-2020-101745 PMid:33106280 DOI: https://doi.org/10.1136/rapm-2020-101745

Aditianingsih D, Pryambodho, Anasy N, Tantri AR, Mochtar CA. A randomized controlled trial on analgesic effect of repeated quadratus lumborum block versus continuous epidural analgesia following laparoscopic nephrectomy. BMC Anesthesiol. 2019;19(1):221. https://doi.org/10.1186/s12871-019-0891-7 PMid:31805855 DOI: https://doi.org/10.1186/s12871-019-0891-7

Tan HS, Taylor C, Weikel D, Barton K, Habib AS. Quadratus lumborum block for postoperative analgesia after cesarean delivery: A systematic review with meta-analysis and trial-sequential analysis. J Clin Anesth. 2020;67:110003. https://doi.org/10.1016/j.jclinane.2020.110003 PMid:32738583 DOI: https://doi.org/10.1016/j.jclinane.2020.110003

Kukreja P, MacBeth L, Sturdivant A, Morgan CJ, Ghanem E, Kalagara H, et al. Anterior quadratus lumborum block analgesia for total hip arthroplasty: A randomized, controlled study. Reg Anesth Pain Med. 44(12), 1075-1079:rapm-2019-100804. https://doi.org/10.1136/rapm-2019-100804 PMid:31653800 DOI: https://doi.org/10.1136/rapm-2019-100804

Sato M. Ultrasound-guided quadratus lumborum block compared to caudal ropivacaine/morphine in children undergoing surgery for vesicoureteric reflux. Pediatric Anesth. 2019;29(7):738-43. https://doi.org/10.1111/pan.13650 PMid:31034730 DOI: https://doi.org/10.1111/pan.13650

Carline L, McLeod GA, Lamb C. A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks. Br J Anaesth. 2016;117(3):387-94. https://doi.org/10.1093/bja/aew224 PMid:27543534 DOI: https://doi.org/10.1093/bja/aew224

Murouchi T, Iwasaki S, Yamakage M. Quadratus lumborum block: Analgesic effects and chronological ropivacaine concentrations after laparoscopic surgery. Reg Anesth Pain Med. 2016;41(2):146-50. https://doi.org/10.1097/AAP.0000000000000349 PMid:26735154 DOI: https://doi.org/10.1097/AAP.0000000000000349