Liposomal Bupivacaine for Quadratus Lumborum Block at the Lateral Supra-Arcuate Ligament in the Analgesic Effect After Laparoscopic Nephrectomy: A Single-Centre, Triple-Blind, Randomized Controlled Trial.

Purpose: Quadratus lumborum block at the lateral supra-arcuate ligament (QLB-LSAL) has demonstrated efficacy in postoperative pain management for laparoscopic nephrectomy patients. Liposomal bupivacaine, a novel sustained-release local anesthetic, provides analgesia lasting up to 72 hours. However, its analgesic effect in QLB-LSAL remains undetermined. This randomized controlled trial aimed to compare the postoperative analgesic efficacy of liposomal bupivacaine versus bupivacaine hydrochloride in patients receiving QLB-LSAL after laparoscopic nephrectomy.

Patients and methods: A total of 116 patients were scheduled to undergo elective laparoscopic nephrectomy under general anesthesia. Patients were randomly assigned to two groups in a 1:1 ratio. The liposomal bupivacaine group (n = 53) received a mixture of 10 mL of liposomal bupivacaine (133mg) and 10 mL of normal saline, totaling 20 mL, while the bupivacaine hydrochloride group (n = 53) received 20 mL of 0.375% bupivacaine hydrochloride. Post-surgical patient-controlled sufentanil analgesia was provided. The primary outcome was total morphine equivalent consumption within the first 48 hours postoperatively.

Results: The total consumption of morphine equivalents within 48 hours postoperatively was significantly lower in the liposomal bupivacaine group than in the bupivacaine hydrochloride group (mean ± SD: 31.8 ± 2.3 vs 20.7 ± 2.8, 95% Confidence Intervals: 10.1 to 12.1, P < 0.001). The liposomal bupivacaine group demonstrated superior postoperative recovery quality (P < 0.05), exceeding the minimal clinically important difference, whereas no significant difference in the incidence of adverse events (P > 0.05) was observed between the two groups.

Conclusion: The findings demonstrated that administration of liposomal bupivacaine in QLB-LASL significantly reduced postoperative opioid consumption while concurrently improving recovery quality in patients undergoing laparoscopic nephrectomy.