Posterior Quadratus Lumborum Block and Its Effect on Stent-Related Urinary Symptoms Following Ureteroscopic Lithotripsy: A Randomised Controlled Trial.
Eylem Yasar, Ilker Akarken, Gizem Akgun, Harun Bal, Bakiye Ugur
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Abstract
Objective: To assess the effect of a single-shot posterior quadratus lumborum block (QLB) on double-J stent-related (DJS-related) lower urinary tract symptoms (LUTS) and postoperative opioid consumption following ureteroscopic lithotripsy (URSL).
Study design: A randomised controlled trial. Place and Duration of the Study: Department of Urology, Mugla Sitki Kocman University, Training and Research Hospital, Mugla, Turkiye, from January to October 2024.
Methodology: A total of 154 patients undergoing unilateral URSL with double-J stent (DJS) placement under spinal anaesthesia were randomly assigned to two groups. The QLB group (n = 77) received a posterior QLB, whereas the Control group (n = 77) received standard care without regional blocking. Postoperative pain was assessed using the Numerical Rating Scale (NRS) at 1, 6, 12, 24, and 48 hours, as well as on day 7. LUTS were assessed with the Ureteral Stent Symptom Questionnaire (USSQ) on day 7 (USSQ-1, during stent indwelling) and five days after stent removal (USSQ-2). Cumulative tramadol consumption within the first 48 hours was also recorded.
Results: Compared with the Control group, the QLB group showed lower USSQ-1 scores (68.05 ± 19.08 vs. 90.22 ± 23.60; p <0.001), improved USSQ-2 scores (43.64 ± 6.04 vs. 52.58 ± 15.13; p <0.001), and reduced tramadol consumption (75.32 ± 101.51 mg vs. 229.87 ± 146.06 mg; p <0.001). Pain scores were consistently lower at all time points except the first hour. No major adverse events were observed.
Conclusion: A single posterior QLB appears to reduce DJS-related LUTS, postoperative pain, and opioid use after URSL. Its inclusion in multimodal analgesia protocols may contribute to improved perioperative care in urological surgery.
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