Efficacy of Posterior Quadratus Lumborum Block for Post-Operative Pain Management in Patients Undergoing Laproscopic Cholecystectomy

Aroosa  Nawaz; Rabia  Ashraf; Iram  Shahzadi; Salman  Iqbal; Adnan Ahmed  Khan; Abid Khan

doi:10.51253/pafmj.v76iSUPPL-2.12802

Authors

Aroosa Nawaz Department of Anaesthesia, Sheikh Khalifa Bin Zayed Al Nahyan Hospital/Combined Military Hospital, Muzaffarabad/ National University of Medical Sciences (NUMS) Pakistan
Rabia Ashraf Department of Anaesthesia, Sheikh Khalifa Bin Zayed Al Nahyan Hospital/Combined Military Hospital, Muzaffarabad/ National University of Medical Sciences (NUMS) Pakistan
Iram Shahzadi Department of Anaesthesia, Sheikh Khalifa Bin Zayed Al Nahyan Hospital/Combined Military Hospital, Muzaffarabad/National University of Medical Sciences (NUMS) Pakistan
Salman Iqbal Department of Anaesthesia, Sheikh Khalifa Bin Zayed Al Nahyan Hospital/Combined Military Hospital, Muzaffarabad/ National University of Medical Sciences (NUMS) Pakistan
Adnan Ahmed Khan Department of Anaesthesia, Sheikh Khalifa Bin Zayed Al Nahyan Hospital/Combined Military Hospital, Muzaffarabad/ National University of Medical Sciences (NUMS) Pakistan
Abid Khan Department of Anaesthesia, Sheikh Khalifa Bin Zayed Al Nahyan Hospital/Combined Military Hospital, Muzaffarabad/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-2.12802

Keywords:

Breakthrough pain, ketorolac, Multimodal analgesia, Nalbuphine, Opioid and quadratus lumborum block

Abstract

Objective: To evaluate the effectiveness of ultrasound guided posterior quadratus lumborum (QL) block against multimodal analgesics for post-operative pain in patients undergoing laproscopic cholecystectomy.

Study Design: Quasi-experimental study.

Place and Duration of Study: Sheikh Khalifa Bin Zayed Al Nahyan Hospital/Combined Military Hospital (SKBZH-CMH), Muzaffarabad, Pakistan, from Jan to Jun 2024.

Methodology: After seeking permission of hospitals ethical committee this Quasi-experimental study was performed with a sample of fifty patients undergoing laproscopic cholecystectomy. The Groups were named as Group Q and Group P after randomization. At the end of surgery, the patients comprising Group Q were given quadratus lumborum block and patients in Group P were given local wound infiltration of local anesthetic along with intravenous ketorolac 30mg. The primary outcome variable was time to first analgesic request.

Results: The mean time to first analgesic request (FAR) in Group Q patients was 9.26±2.21 hours and the mean time to first analgesic request (FAR) in Group M patients was 3.66±1.37 hours with p value of less than 0.001. There were 24(92.3%) patients who were satisfied with linker score greater than four in Group Q while only 2(7.7%) patients conveyed dissatisfaction. There were 9(37.5%) patients who were satisfied with linker score greater than four in Group M while 24(62.5%) patients were not satisfied with p-value <0.001.

Conclusion: We arrived at the conclusion that quadratus lumborum block prolongs the time to breakthrough pain in patients with laproscopic cholecyctectomy compared to intravenous multimodal analgesia.

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References

1. Hirose M, Okutani H, Hashimoto K, Ueki R, Shimode N, Kariya N, et al. Intraoperative assessment of surgical stress response using nociception monitor under general anesthesia and postoperative complications: a narrative review. J Clin Med 2022; 11(20): 6080.

https://doi.org/10.3390/jcm11206080

2. Chatchumni M, Eriksson H, Mazaheri M. Core components of an effective pain management education programme for surgical nurses: A Delphi study. Int J Qualit Stud Health Well-being 2022; 17(1): 2110672.

https://doi.org/10.1080/17482631.2022.2110672

3. Shivakumar CR, Noola GS. A comparative study of conventional cholecystectomy and laparoscopic cholecystectomy. Int Surg J 2016; 3(2): 707-710.

https://doi.org/10.21608/bjas.2021.188695

4. Chang W, Yoo T, Cho WT, Cho G. Comparing postoperative pain in various pressure pneumoperitoneum of laparoscopic cholecystectomy: A double-blind randomized controlled study. Ann Surg Treat Res 2021; 100(5): 276-281.

https://doi.org/10.4174/astr.2021.100.5.276

5. Kamel RK, Abdelwahab MM, Abdalazem ES. Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic and open cholecystectomy. Benha J Appl Sci 2021; 6(3): 83-91.

6. Liang M, Xv X, Ren C, Yao Y, Gao X. Effect of ultrasound-guided transversus abdominis plane block with rectus sheath block on patients undergoing laparoscopy-assisted radical resection of rectal cancer: a randomized, double-blind, placebo-controlled trial. BMC Anesthesiol 2021; 21(3): 1-9.

https://doi.org/10.1186/s12871-021-01295-9

7. Ueshima H, Otake H, Lin JA. Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. BioMed research international. 2017; (1): 2752876.

https://doi.org/10.1155/2017/2752876

8. Fouad AZ, Abdel-Aal IRM, Gadelrab MRMA, Mohammed HME-HS. Ultrasound-guided transversalis fascia plane block versus transmuscular quadratus lumborum block for post-operative analgesia in inguinal hernia repair. Korean J Anesthesiol 2021; 34(2): 201-209.

https://doi.org/10.3344/kjp.2021.34.2.201

9. Kacan M, Gulec H, Horasanli E. Comparison Of Transversus Abdominis Plan Block And Quadratus Lumborum Block For Postoerative Pain Control Following Laparoscopic Cholecystectomy. Res Sq 2024.

https://doi.org/10.21203/rs.2.19971/v2

10. Baytar Ç, Yılmaz C, Karasu D, Topal S. Comparison of Ultrasound-Guided Subcostal Transversus Abdominis Plane Block and Quadratus Lumborum Block in Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Clinical Study. Pain Res Manag 2019; 2019: 2815301.

https://doi.org/10.1155/2019/2815301

11. Aly NS, Mansour HS, Ahmed MA. Ultrasound-Guided Quadratus Lumborum Block Using Bupivacaine versus Bupivacaine-Dexamethasone for Postoperative Analgesia in Laparoscopic Cholecystectomy. Malaysian J Med Res 2019; 30(3): 109-112. https://doi.org/10.21608/mjmr.2022.221881

12. Baytar Ç, Yılmaz C, Karasu D, Topal S. Comparison of Ultrasound-Guided Subcostal Transversus Abdominis Plane Block and Quadratus Lumborum Block in Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Clinical Study. Pain Res Manag 2019: 2815301.

https://doi.org/10.1155/2019/2815301

13. Nemoto T, Beglar D. Developing Likert-scale questionnaires. In N. Sonda & A. Krause (Eds.), JALT2013 Conference Proceedings. Tokyo: JALT, 2014.

14. Luo J, Min S. Postoperative pain management in the postanesthesia care unit: an update. J Pain Res 2017; 10: 2687-2698. https://doi.org/10.2147/JPR.S142889

15. Vishal U, Retter S, Kehoe E, McKeen DM. Quadratus lumborum block for postoperative analgesia: a systematic review and meta-analysis. Can J Anaesth 2020; 67(11): 1557-1575.

https://doi.org/10.1007/s12630-020-01793-3

16. Lin C, Wang X, Qin C, Liu J. Ultrasound-guided posterior quadratus lumborum block for acute postoperative analgesia in adult patients: a meta-analysis of randomized controlled trials. Ther Clin Risk Manag 2022: 299-313.

https://doi.org/10.2147/TCRM.S349494

17. Ahmad AH, Kasem AA, Tolba MA. Posterior quadratus lumborum versus caudal epidural block for perioperative analgesia in pediatric patients undergoing upper abdominal surgeries: Arandomized, double-blind trial. Eur J Anaesthesiol 2024; 40(1): 24-33.

https://doi.org/10.1080/11101849.2023.2297327

18. Tarek MA, Thabet GSM, Abdelmaboud A. Ultrasound-guided quadratus lumborum block versus transversus abdominis plane block for post-operative pain after caesarean delivery. Med J Cairo Univ 2022; 90(3): 91-97.

https://doi.org/10.21608/mjcu.2022.234831

19. Chilkoti GT, Gaur D, Saxena AK, Gupta A, Agarwal R, Jain S. Ultrasound-guided transversalis fascia plane block versus wound infiltration for both acute and chronic post-caesarean pain management–A randomised controlled trial. Indian J Anaesth 2022; 66(7): 517.

https://doi.org/10.4103/ija.ija_173_2