Transmuscular quadratus lumborum block for percutaneous nephrolithotomy reduces opioid consumption and speeds ambulation and discharge from hospital: a single centre randomised controlled trial

• Published in: British journal of anaesthesia : BJA Vol. 123; no. 2; pp. e350 - e358
• Main Authors: Dam, Mette, Hansen, Christian K., Poulsen, Troels D., Azawi, Nessn H., Wolmarans, Morné, Chan, Vincent, Laier, Gunnar H., Bendtsen, Thomas F., Børglum, Jens
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2019; Elsevier
• Subjects: Abdominal Muscles - drug effects; Adult; Aged; Aged, 80 and over; Analgesics, Opioid - administration & dosage; Double-Blind Method; Early Ambulation - statistics & numerical data; Female; Humans; length of hospital stay; local anaesthetic; Male; Middle Aged; multimodal analgesia; Nephrolithotomy, Percutaneous; nerve block; Nerve Block - methods; Pain, Postoperative - drug therapy; Patient Discharge - statistics & numerical data; Perioperative Pain Assessment and Management; postoperative pain; Prospective Studies; quadratus lumborum block; ultrasonography; local anaesthetic; ultrasonography; multimodal analgesia; postoperative pain; length of hospital stay; quadratus lumborum block; nerve block
• DOI: 10.1016/j.bja.2019.04.054
• ISSN: 0007-0912; 1471-6771

Percutaneous nephrolithotomy (PNL) is associated with severe postoperative pain. The current study aimed to investigate the analgesic efficacy of transmuscular quadratus lumborum (TQL) block for patients undergoing PNL surgery. Sixty patients were enrolled in this single centre study. The multimodal analgesic regime consisted of oral paracetamol 1 g and i.v. dexamethasone 4 mg before surgery and i.v. sufentanil 0.25 μg kg−1 30 min before emergence. After operation, patients received paracetamol 1 g regularly at 6 h intervals. Subjects were allocated to receive a preoperative TQL block with either ropivacaine 0.75%, 30 ml (intervention) or saline 30 ml (control). Primary outcome was oral morphine equivalent (OME) consumption 0–6 h after surgery. Secondary outcomes were OME consumption up to 24 h, pain scores, time to first opioid, time to first ambulation, and hospital length of stay. Results were reported as mean (standard deviation) or median (inter-quartile range). Morphine consumption was lower in the intervention group at 6 h after surgery (7.2 [8.7] vs 90.6 [69.9] mg OME, P<0.001) and at 24 h (54.0 [36.7] vs 126.2 [85.5] mg OME, P<0.001). Time to first opioid use was prolonged in the intervention group (678 [285–1020] vs 36 [19–55] min, P<0.0001). Both the time to ambulation (302 [238–475] vs 595 [345–925] min, P<0.004) and length of stay (2.0 [0.8] vs 3.0 [1.2] days, P≤0.001) were shorter in the intervention group. This is the first blinded, RCT that confirms that unilateral TQL block reduces postoperative opioid consumption and hospital length of stay. Further study is required for confirmation and dose optimisation. NCT02818140.