Dataset Information

[Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case].

ABSTRACT:

Background and objectives

Bilateral quadratus lumborum block has been described for major abdominal procedures when sepsis is present, because risks associated to epidural are considered elevated. In an open aortic surgery, a single-shot bilateral quadratus lumborum block type 1 may be an alternative to thoracic epidural block for post-operative analgesia in a patient having an increased cumulative risk for thoracic epidural hematoma.

Case report

A 56-year-old female patient presenting controlled hypertension, chronic renal disease stage 3b, dyslipidemia and a platelet count of 102,000/μl, and taking aspirin, was scheduled for bilateral aortoiliac endarterectomy. She was submitted to a sole general anesthesia plus, at end of the surgery, a bilateral quadratus lumborum block type 1 for post-operative analgesia with 20mL of ropivacaine 0.5%, per side, before extubation. Immediately after post anesthesia care unit admission, patient developed moderate hypotension (dopamine infusion was needed during 18h), concomitantly with a rapid reduction in the pain scores. Low numeric rating scale and opioid consumption were noted, particularly in the first 24h post-operatively.

Conclusions

Quadratus lumborum block was an effective analgesic technique for open aortic surgery in this case, although hypotension associated to bilateral quadratus lumborum block type 1 may occur. Associated sympathetic block probably related to the bilateral paravertebral extension of the block, may contribute for post-operative hypotension associated to reperfusion-ischemia syndrome in a patient that had long-lasting intraoperative aortic cross-clamping. The use of high concentration of local anesthetic to obtain longer duration of action of a single-shot quadratus lumborum block to avoid thoracic epidural or bilateral quadratus lumborum block catheterization should be used judiciously.

SUBMITTER: Almeida C

PROVIDER: S-EPMC9391694 | biostudies-literature | 2018 Nov - Dec

REPOSITORIES: biostudies-literature

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Publications

[Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case].

Almeida Carlos C Assunção José Pedro JP

Brazilian journal of anesthesiology (Elsevier) 20180820 6

<h4>Background and objectives</h4>Bilateral quadratus lumborum block has been described for major abdominal procedures when sepsis is present, because risks associated to epidural are considered elevated. In an open aortic surgery, a single-shot bilateral quadratus lumborum block type 1 may be an alternative to thoracic epidural block for post-operative analgesia in a patient having an increased cumulative risk for thoracic epidural hematoma.<h4>Case report</h4>A 56-year-old female patient prese ...[more]

PMID: 30139667

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Project description:BackgroundThe postoperative analgesic effect of transmuscular quadratus lumborum block (QLB-TM) in patients following lower abdominal surgeries has been identified; however, the efficacy of QLB using the lateral approach (QLB-L) is still in debate. Therefore, this retrospective study was conducted to investigate the effect of a single-shot block with QLB-L on postoperative analgesia for patients undergoing percutaneous nephrolithotomy (PCNL).MethodsThe medical information of the patients undergoing PCNL was retrieved from the electronic charter system (Medisystem, Suzhou, China) in our Nanjing Drum Tower Hospital during the period of Jan/2019 to Jun/2019. Among the total of 57 patients, there are 17, 18, and 22 patients subjected to QLB-L, QLB-TM, or routine treatment, respectively. The primary observational parameter was to assess postoperative pain with visual analog scales (VAS) at rest 30 min after extubation, 24 h, and 48 h after surgery, respectively. The secondary observatory endpoints, including the consumption of intraoperative opioids, the cumulative dose of non-steroid anti-inflammatory drugs (NSAIDs) and the incidence of adverse events related to postoperative analgesia, were evaluated as well.ResultsThe static VAS score at 24 h after surgery and the intraoperative consumption of sufentanil were significantly lower in patients receiving either intervention of QLB-L or QLB-TM as compared with those receiving routine treatment. However, one shot of QLB had no impact on VAS scores at 30 min post-extubation, 48 h after PCNL procedure compared with the patients receiving routine treatment. The percentage of non-ambulatory patients within 24 h post-PCNL was significantly higher in the QLB-TM group compared with the routine treatment group (P = 0.04). There were no significant differences in the incidence of postoperative nausea and vomit (PONV), itches, respiratory depression, the time for the first defecation, and the length of hospital stay (LOS) among the three groups.ConclusionsQLB-L procedure may exert as equivalent as QLB-TM in terms of abrogating postoperative pain within 24 h post-surgery and decreasing intraoperative sufentanil consumption in patients undergoing PCNL procedure as well. The caution should be taken to avoid lower extremities weakness in the patients after QLB-TM within the first 24 h post-PCNL procedure.

Project description:BackgroundAchieving optimal analgesia with few side effects is the goal of pain management after cesarean delivery. Intrathecal (IT) morphine is the current standard but ultrasound-guided quadratus lumborum block (QLB) may offer superior pain control with fewer side effects. This study compared the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine, with IT morphine and bilateral QLB, or only bilateral QLB.MethodsParturients having elective cesarean delivery under spinal block were randomized and allocated into IT morphine 0.2 mg with sham QLB (Group IT), IT morphine 0.2 mg and bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group IT+QLB), or bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group QLB). A PCA pump was connected after completion of the QLB or sham block. The first time to PCA morphine requirement was recorded and compared.ResultsEighty parturients were included. Analysis of Group QLB was terminated early because at the second interim analysis, median pain-free period was significantly shorter in Group QLB [hours (95%CI): 2.50 (1.04-3.96) in Group IT vs. 7.75 (5.67-9.83) in IT+QLB vs. 1.75 (0.75-2.75) in QLB (p < 0.001)]. The median (min, max) amount of morphine required during 24 h was 5.5 (0-25) in Group IT vs. 5.0 (0-36) in IT+QLB vs. 17.5 (1-40) mg in Group QLB (p < 0.001). In the final analysis the median pain-free period was 2.50 (1.23-3.77) hours (95%CI) in Group IT (n = 27) vs. 8.02 (5.96-10.07) in IT+QLB (n = 28). (p = 0.027).ConclusionUS-QLB used in conjunction with IT morphine yielded a statistically significant longer median pain-free period compared with standard IT morphine alone. However, QLB alone provided inferior pain control compared with standard IT morphine. When combined with IT morphine, QLB could provide additional analgesic benefit as a part of multimodal analgesic regimen, especially during the early postoperative period.Trial registrationClinicalTrials.gov no. NCT03199170 Date registered on June 22, 2017. Prospectively registered.

Dataset Information

[Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case].

Background and objectives

Case report

Conclusions

Publications

[Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case].

Similar Datasets

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