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  • Anterior quadratus lumborum block for analgesia after living-donor renal transplantation: a double-blinded randomized controlled trial

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Regional anesthesia and acute pain
Anterior quadratus lumborum block for analgesia after living-donor renal transplantation: a double-blinded randomized controlled trial
  1. Youngwon Kim1,
  2. Jin-Tae Kim2,
  3. Seong-Mi Yang3,
  4. Won Ho Kim2,
  5. Ahram Han4,
  6. Jongwon Ha4,
  7. Sangil Min4 and
  8. Sun-Kyung Park1
  1. 1 Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
  2. 2 Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  3. 3 Department of Anesthesiology and Pain Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea (the Republic of)
  4. 4 Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  1. Correspondence to Dr Sun-Kyung Park, Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea (the Republic of); mayskpark{at}gmail.com

Abstract

Introduction Limited non-opioid analgesic options are available for managing postoperative pain after renal transplantation. We aimed to investigate whether the unilateral anterior quadratus lumborum (QL) block would reduce postoperative opioid consumption after living-donor renal transplantation in the context of multimodal analgesia.

Methods Eighty-eight adult patients undergoing living-donor renal transplantation were randomly allocated to receive the unilateral anterior QL block (30 mL of ropivacaine 0.375%) or sham block (normal saline) on the operated side before emergence from anesthesia. All patients received standard multimodal analgesia, including the scheduled administration of acetaminophen and fentanyl via intravenous patient-controlled analgesia. The primary outcome was the total opioid consumption during the first 24 hours after transplantation. The secondary outcomes included pain scores, time to first opioid administration, cutaneous distribution of sensory blockade, motor weakness, nausea/vomiting, quality of recovery scores, time to first ambulation, and length of hospital stay.

Results The total opioid consumption in the first 24 hours after transplantation did not differ significantly between the intervention and control groups (median (IQR), 160.5 (78–249.8) vs 187.5 (93–309) oral morphine milligram equivalent; median difference (95% CI), −27 (−78 to 24), p=0.29). No differences were observed in the secondary outcomes.

Conclusions The anterior QL block did not reduce opioid consumption in patients receiving multimodal analgesia after living-donor renal transplantation. Our findings do not support the routine administration of the anterior QL block in this surgical population.

Trial registration number NCT04908761.

  • Nerve Block
  • analgesia
  • Pain, Postoperative
  • Acute Pain

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/rapm-2023-104788

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • SM and S-KP contributed equally.

    • Contributors YK: study design, funding acquisition, block performance, data analysis, manuscript writing and editing, approval of the final manuscript. J-TK: conduct, interpreting the data, data analysis, approval of the final manuscript. S-MY: conduct, interpreting the data, approval of the final manuscript. WHK: conduct, interpreting the data, approval of the final manuscript. AH: conduct, acquisition of data, approval of the final manuscript. JH: conduct, acquisition of data, approval of the final manuscript. SM: guarantor, study design, planning, manuscript editing, approval of the final manuscript. S-KP: guarantor, study design, planning, funding acquisition, block performance, data analysis, manuscript writing and editing, approval of the final manuscript.

    • Funding Support for this study was received solely from institutional sources. This study was supported by grant No. 04-2021-0630 conferred by the Seoul National University Hospital Research Fund. The sponsor had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.