The efficacy and safety of continuous transmuscular quadratus lumborum block for postoperative analgesia after laparoscopic nephrectomy: A prospective randomized clinical trial.

Background and aims: Analgesic efficacy and safety of continuous catheter technique in transmuscular quadratus lumborum block (QLB3) for laparoscopic nephrectomy has not been studied. This study was planned to evaluate the efficacy and safety of ultrasound (US)-guided continuous QLB3 for postoperative analgesia after laparoscopic nephrectomy.

Material and methods: In this randomized, open-label, single-centered trial, 64 patients belonging to the American Society of Anesthesiologists, physical status grade I and II, 18-65 years of age, scheduled for laparoscopic nephrectomy were included. Patients were randomized into the QLB group and the control group. After surgery, the QLB group received transmuscular QLB with a 0.4 mL/kg bolus of 0.25% ropivacaine and catheter insertion for continuous infusion of 0.25% ropivacaine at 0.1 mL/kg/h. Patients in both groups received fentanyl (0.5 μg/kg) as rescue analgesia by IV PCA pump.

Results: The data of 30 patients in each group were analyzed. Total fentanyl consumption during the first 48 h postoperatively was significantly lower in the QLB group compared to the control group (mean ± SD; QLB group = 74.33 ± 32.75 μg; control group = 209.10 ± 52.04 μg) (P < 0.001). Postoperative NRS pain scores at rest and on movement were significantly lower in the QLB group compared to the control group at various time intervals up to 48 h postoperative (P < 0.05). No severe complications were seen in any of the patients.

Conclusions: US-guided continuous catheter transmuscular QLB reduced postoperative opioid consumption by 64.45% and decreased NRS pain scores after laparoscopic nephrectomy without complications.