Dataset Information

Effect of interfascial pressure on block success during anterior quadratus lumborum block application: a prospective observational study.

ABSTRACT:

Background

The quadratus lumborum block (QLB) has recently been used frequently for postoperative analgesia after abdominal surgery. The aim of this study was to investigate the effect of pressure changes between the middle thoracolumbar fascia layers to which the anterior QLB (aQLB) is applied at the level of the sensory block.

Methods

A total of 67 patients planned to undergo laparoscopic cholecystectomy were evaluated in the context of this prospective study. Bilateral aQLBs were administered to all patients, and a peripheral nerve block catheter was placed between the psoas and quadratus lumborum muscles. The correlation of interfascial pressures (IFPs) during block application, 30 min intraoperatively, and 30 min postoperatively with the sensory block level was determined as the primary outcome measure. Secondary outcome measures were the sensory block levels 30 min after block application and 30 min postoperatively; visual analog scale scores 30 min and 6, 12, and 24 h postoperatively; and 24 h tramadol consumption.

Results

The preoperatively and intraoperatively measured IFPs differed significantly between the right and left sides (P < 0.05). The preoperative and postoperative block levels also differed significantly between the right and left sides (P < 0.05). The preoperative and postoperative block levels and preoperatively measured IFPs showed a weakly negative correlation (right: r = 0.374; left: r = 0.470).

Conclusions

The results of this study show that pressure changes between the fasciae may be effective in aQLB application.

SUBMITTER: Okmen K

PROVIDER: S-EPMC10410551 | biostudies-literature | 2023 Jul

REPOSITORIES: biostudies-literature

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Effect of interfascial pressure on block success during anterior quadratus lumborum block application: a prospective observational study.

Ökmen Korgün K Yıldız Durdu K DK

Anesthesia and pain medicine 20230714 3

<h4>Background</h4>The quadratus lumborum block (QLB) has recently been used frequently for postoperative analgesia after abdominal surgery. The aim of this study was to investigate the effect of pressure changes between the middle thoracolumbar fascia layers to which the anterior QLB (aQLB) is applied at the level of the sensory block.<h4>Methods</h4>A total of 67 patients planned to undergo laparoscopic cholecystectomy were evaluated in the context of this prospective study. Bilateral aQLBs we ...[more]

PMID: 37468205

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Project description:ObjectiveAnterior quadratus lumborum block at the lateral supra-arcuate ligament (QLBA) is a new method for postoperative pain relief in patients undergoing abdominal surgery. Perioperative QLBA is effective, but it has not been compared with posterior quadratus lumborum block (QLB2). The present study aims to evaluate the postoperative pain of patients undergoing laparoscopic nephrectomy surgery with QLBA versus QLB2.Methods/designThis study is a randomised, prospective, parallel group, non-inferior trial. All patients undergoing laparoscopic nephrectomy surgery will be randomised 1:1 to the QLBA group or the QLB2 group with general anaesthesia. The objective of the trial is to evaluate the postoperative pain of patients undergoing laparoscopic nephrectomy surgery with QLBA (n=50) versus QLB2 (n=50). The primary outcome for this trial is the Visual Analogue Scale scores at rest and activity (dynamic pain scores are assessed with a cough or a trial to sit up in bed) 2 hours after surgery between patients who receive QLBA versus QLB2. The secondary objectives will be to compare (1) pain at rest and activity 0.5 hour, 2 hours, 24 hours, 48 hours after surgery; (2) the time spent on block operation; (3) the blocked dermatomal coverage 5 min and 15 min after block operation; (4) intraoperative opioid consumption; (5) types and doses of the rescue analgesic after surgery; (6) nausea and vomiting score within 24 hours after surgery; (7) time from the end of surgery to the first onset significant pain; (8) patient satisfaction score.DiscussionClinical experience has supported that QLB is a very effective postoperative analgesic method, and we will answer the following questions in this trial: Will both approaches have the same analgesic effect and duration? Will the QLBA have a non-inferior postoperative analgesic effect compared with QLB2 or the QLBA be able to prolong the duration of analgesia after surgery? The results of this study could have actual clinical applications that could help to reduce postoperative pain and shorten hospital stays.Ethics and disseminationThe study design was approved by the ethical committee of Beijing Chao-Yang Hospital, Beijing, China (2020-ke-321). The trial results will be published in peer-reviewed journals and at conferences.Trial registration numberChiCTR2000035354.

Project description:BackgroundCurrently, the prevalence of obesity is on the rise annually. Bariatric surgery stands out as the most efficacious approach for addressing obesity. Obese patients are more prone to experience moderate to severe pain after surgery due to lower pain thresholds. Regional block, as an important component of multimodal analgesia in bariatric surgery, is crucial in reducing opioid consumption and alleviating postoperative pain in patients undergoing bariatric surgery. Transversus abdominis plane block (TAPB) has gained widespread utilization in bariatric surgery; however, its limitation of inadequate reduction of visceral pain in obese patients remains a significant concern. Therefore, it is imperative to explore new and more efficient strategies for analgesia. Quadratus lumborum block (QLB) has emerged as a popular nerve block in recent years, frequently utilized in conjunction with general anesthesia for abdominal surgery. In the cadaver study of QLB, it was confirmed that the dye level could reach up to T6 when using the subcostal anterior quadratus lumborum muscle approach, which could effectively reduce the incision pain and visceral pain of bariatric surgery patients during the perioperative period. However, there is currently a lack of research on the use of subcostal anterior QLB in patients undergoing bariatric surgery. Our study aims to investigate whether subcostal anterior QLB can provide superior perioperative analgesic efficacy for bariatric surgery under general anesthesia compared to TAPB, leading to reduced postoperative opioid consumption and a lower incidence of postoperative nausea and vomiting (PONV).Methods and designThis study is a prospective, randomized controlled trial aiming to recruit 66 patients undergoing bariatric surgery. The participants will be randomly allocated into two groups in a 1:1 ratio: subcostal anterior QLB group (n = 33) and TAPB group (n = 33). The study aims to investigate the efficacy of subcostal anterior QLB and TAPB in obese patients who are scheduled to undergo bariatric surgery. Our primary outcome is to observe the amount of opioids used in the two groups 24 h after operation. The secondary outcomes included VAS of pain during rest/activity after operation, the type and dose of additional analgesics, the occurrence and severity of PONV, the type and dose of additional antiemetic drugs, postoperative anesthesia care unit (PACU) time, time of first postoperative exhaust, time to first out of bed activity, time to first liquid diet and postoperative admission days.DiscussionOpioid analgesics are prone to causing adverse reactions such as nausea, vomiting, and respiratory depression, especially in obese patients. Multimodal analgesia, including nerve block, can effectively reduce the dose of opioids and alleviate their adverse effects. Currently, TAPB is the most prevalent nerve block analgesia method for abdominal surgery. Recent studies have indicated that subcostal anterior QLB offers advantages over TAPB, including a wider block plane, faster onset, and longer maintenance time. It is not clear which of the two nerve block analgesia techniques is better for postoperative analgesia in patients undergoing bariatric surgery. Our objective in this investigation is to elucidate the superior method between TAPB and subcostal anterior QLB for postoperative pain management in bariatric surgery.Trial registrationChiCTR ChiCTR2300070556. Registered on 17 April 2023.

Project description:Elderly patients with various comorbidities are more likely to suffer from proximal femur fractures. It is also a painful fracture, and poor pain management can have serious physiological and psychological consequences, such as acute delirium. Purpose. The aim of this study is to compare the efficacy of ultrasound-guided transmuscular (anterior) quadratus lumborum block (QLB) versus infrainguinal fascia iliaca compartment block (FICB) in proximal femur fractures for postoperative analgesia. Patient-reported pain on the visual analogue scale (VAS), analgesic demand, and ambulation were the key factors. Patients and Methods. This prospective, randomised trial was done after receiving approval from the institute' study ethical committee. In this study, ultrasound-guided infrainguinal fascia iliaca compartment block was compared to ultrasound-guided anterior quadratus lumborum block using 50 ml of bupivacaine 0.25%, with a maximum dose of 2.5 mg/kg at the end of surgery after spinal anaesthesia in 128 patients (64 patients in each group). Nalbuphine was given as rescue analgesia if VAS >3. Our 1st outcome was the first rescue analgesia and total analgesic consumption in the 1st 24 hours; the 2nd outcome was the time patients started to ambulate. Results. Postoperative pain perception was substantially greater in the FICB group starting from 30 min (P value 0.022) till 24 hours (P value <0.001), and they received a considerably larger total narcotic dose (14.1 ± 3.5) than patients in the QLB group (7.9 ± 3.4), P value (<0.001 ∗ ). The time required to achieve first rescue analgesia was much less in the FICB group (8.5 ± 2.2) compared to the QLB group (14.1 ± 4.5), P value (<0.001 ∗ ), and they took much longer to ambulate (22.3 ± 4.8) when compared to the QLB group (20.1 ± 4.6), P value (0.011 ∗ ). Hypotension (1.6%) was detected mainly in the QLB group, whereas poor fascial separation (1.6%) was observed only in the FICB group. There were no significant differences in complications between both the FICB and QLB groups. Conclusion. Patients receiving postoperative anterior QL block for proximal femur fracture demonstrated delayed first rescue analgesia and lower total nalbuphine consumption with early ambulation than patients who received FICB.

Dataset Information

Effect of interfascial pressure on block success during anterior quadratus lumborum block application: a prospective observational study.

Background

Methods

Results

Conclusions

Publications

Effect of interfascial pressure on block success during anterior quadratus lumborum block application: a prospective observational study.

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