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Original research
Transmuscular quadratus lumborum block reduces opioid consumption and prolongs time to first opioid demand after laparoscopic nephrectomy
  1. Mette Dam1,
  2. Christian Hansen1,
  3. Troels Dirch Poulsen1,
  4. Nessn Htum Azawi2,
  5. Gunnar Hellmund Laier3,
  6. Morné Wolmarans4,
  7. Vincent Chan5,
  8. Thomas Fichtner Bendtsen6 and
  9. Jens Børglum1,7
  1. 1Department of Anaesthesiology, Zealand University Hospital, Roskilde, Denmark
  2. 2Department of Urology, Zealand University Hospital, Roskilde, Denmark
  3. 3Nørresundby, Denmark
  4. 4Anaesthesiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
  5. 5Anesthesia, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  6. 6Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
  7. 7Department of Clinical Medicine, Faculty of Health and Clinical Science, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Jens Børglum, Department of Anesthesiology, Zealand University Hospital, Roskilde 4000, Denmark; jens.borglum{at}gmail.com

Abstract

Background Robotic and hand-assisted laparoscopic nephrectomies are often associated with moderate to severe postoperative pain. The aim of the current study was to investigate the analgesic efficacy of the transmuscular quadratus lumborum (TQL) block for patients undergoing robotic or hand-assisted laparoscopic nephrectomy.

Methods Fifty patients were included in this single-center study. All patients were scheduled for elective hand-assisted or robotic laparoscopic nephrectomy under general anesthesia. Preoperatively, patients were randomly allocated to TQL block bilaterally with ropivacaine 60 mL 0.375% or 60 mL saline and all patients received standard multimodal analgesia and intravenous patient-controlled analgesia. Primary outcome was postoperative oral morphine equivalent (OME) consumption 0–12 hours. Secondary outcomes were postoperative OME consumption up to 24 hours, pain scores, time to first opioid, nausea/vomiting, time to first ambulation and hospital length of stay (LOS).

Results Mean (95% CI) OME consumption was significantly lower in the intervention group at 12 hours after surgery 50 (28.5 to 71.5) mg versus control 87.5 (62.7 to 112.3) mg, p=0.02. At 24 hours, 69.4 (43.2 to 95.5) mg versus 127 (96.7 to 158.6) mg, p<0.01. Time to first opioid was significantly prolonged in the intervention group median (IQR) 4.4 (2.8–17.6) hours compared with 0.3 (0.1–1.0) hours in the control group, p<0.001. No significant intergroup differences were recorded for time to first ambulation, pain scores, nausea/vomiting nor for LOS.

Conclusion Preoperative bilateral TQL block significantly reduced postoperative opioid consumption by 43% and significantly prolonged time to first opioid.

Trial registration number NCT03571490.

  • regional anesthesia
  • pain
  • postoperative
  • anesthesia
  • local
  • ultrasonography

https://doi.org/10.1136/rapm-2020-101745

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    Footnotes

    • Contributors MD, JB, GHL, NHA, MW and VC designed/planned the study. MD, CH, TDP and JB conducted the study. GHL, MD, JB and TFB analyzed the data. MD and JB wrote the paper. MD, JB, TFB, GHL, NHA, CH, TDP, MW and VC revised the paper. All authors approved the final version of the manuscript.

    • Funding The study was supported by the Research Foundation of Region Zealand.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This prospective, single-center, double-blinded RCT was approved by The Danish Medicines Agency (EudraCT 2017-002130-23), The Regional Ethics Committee (SJ-624) and the Danish Data Protection Agency.

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

    • Data availability statement Data are available upon reasonable request. We will have to ask the Ethical Committee before we hand over any data to people outside the research group.