Background and aims Analgesic efficacy of quadratus lumborum block (QLB) has been proven for lower abdominal surgery but not for other types of abdominal surgeries. The aim of this retrospective cohort study was to compare QLB and epidural anesthesia (EA) with respect to postoperative analgesic effect for robot-assisted partial nephrectomy.
Methods After institutional review board approval and informed consent, we reviewed the medical charts of 111 ASA-PS 1–2 patients who underwent robot-assisted partial nephrectomy under general anesthesia with QLB using 0.125–0.25% levobupivacaine 20–40 ml or EA between October 2015 and September 2018. We performed propensity-score matching by using patient characteristics.
The primary outcome was the additional analgesic requirement within the first 24 hours. The secondary outcomes included intraoperative fentanyl and remifentanil requirements, incidence of PONV, and first ambulation times.
The QLB and EA groups were compared using Mann-Whitney U test or chi-square test, where appropriate. A p<0.05 was considered statistically significant.
Results There were 59 cases of QLB and 52 cases of EA during the study period. After matching, 52 cases each were analyzed. Even after matching, the fraction of QLB patients who received postoperative patient-controlled intravenous administration of fentanyl was small compared to the EA patients who received postoperative continuous epidural fentanyl (23.1% vs. 51.9%, p=0.004). Compared to EA group, QLB group requested additional analgesics more often (median 1 [IQR 0–2] vs. 0[0–0], p<0.001). Intraoperative fentanyl and remifentanil requirements were also larger in QLB group (table 1).
Conclusions QLB does not appear to provide an advantage over EA regarding analgesia for robot-assisted partial nephrectomy.