Comparison of the postoperative analgesic effects of ultrasound-guided quadratus lumborum block and transversus abdominis plane block after inguinal hernia repair

doi:10.3877/cma.j.issn.1674-392X.2021.06.018

Abstract

Abstract:

Objective

To compare the postoperative analgesic effects of quadratus lumborum block and transversus abdominis plane block in patients undergoing inguinal hernia repair.

Methods

This is a self-matched, left-right control, double-blind study. Forty-two male patients, aged 60 to 80 years, with BMI of 21 to 26 kg/m², ASA physical status of Ⅰ to Ⅲ, undergoing elective bilateral inguinal hernia repair were enrolled in this study. According to the random number table, they were divided into two groups: quadratus lumborum block group (group Q) and transversus abdominis plane block group (group T). The left side was group Q and the right side was group T when the random number was odd number. Conversely, the left side was group T and the right side was group Q when the random number was even number. Group Q received quadratus lumborum block while group T received transversus abdominis plane block. All the patients were given 20 ml of 0.375% ropivacaine under either of these two nerve blocks. All the patients received the same general anesthesia. The extubation time, visual analogue scale (VAS) at rest and on movement at 2, 4, 8, 12, 24, and 48 hours postoperative, the use of rescue analgesia, the duration of bilateral nerve block were recorded. We also recorded, complications of nerve block such as hematoma, visceral injury, local anesthetic poisoning, infection of puncture site and the incidences of adverse effects such as nausea and vomiting.

Results

The VAS scores at rest and on movement in group Q post-operative 12, 24, 48 h were lower than those in group T (P<0.05). The durations of analgesia were longer in group Q than that in group T (P<0.05). Eleven patients (26.2%) and thirteen patients (31.0%) needed rescue analgesia 24 and 48 h after operation respectively. No complications of nerve block such as hematoma, visceral injury, local anesthetic intoxication, and infection of puncture site were observed in both groups. Six patients (14.3%) suffered from nausea and vomiting after surgery.

Conclusion

The results of this study showed that in patients undergoing inguinal hernia repair, the quadratus lumborum block provided safe, longer and more effective postoperative analgesia compared with the transversus abdominis plane block.

Key words: Hernia, inguinal, Herniorrhaphy, Quadratus lumborum block, Transversus abdominis plane block, Pain

Juehao Zhang, Kai Zhang, Xuelin Yang. Comparison of the postoperative analgesic effects of ultrasound-guided quadratus lumborum block and transversus abdominis plane block after inguinal hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(06): 617-620.

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References 19

[1]	Urits I, Ostling PS, Novitch MB, et al. Truncal regional nerve blocks in clinical anesthesia practice[J]. Best Pract Res Clin Anaesthesiol, 2019, 33(4): 559-571.
[2]	D'Ercole F, Arora H, Kumar PA. Paravertebral block for thoracic surgery[J]. J Cardiothorac Vasc Anesth, 2018, 32(2): 915-927.
[3]	张珏颢，杨学林，张凯. 腹横肌平面阻滞在腹股沟疝修补术患者术后快速康复中的作用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2020, 14(3): 233-237.
[4]	杨学林，张凯，杜颖, 等. 超声引导下腹横肌平面阻滞对老年腹股沟疝修补术患者术后疼痛的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2017, 11(6): 441-444.
[5]	付越，刘俊艳. 超声引导腹横肌平面阻滞复合右美托咪定对老年腹股沟斜疝手术患者麻醉效果的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2020, 14(3): 243-246.
[6]	Wang Y, Wang X, Zhang K. Correction to: effects of transversusabdominis plane block versus quadratuslumborum block on postoperative analgesia: a meta-analysis of randomized controlled trials[J]. BMC Anesthesiol, 2020, 20(1): 128.
[7]	韩彬，王武涛，何爱萍. 超声引导下腰方肌阻滞或腹横肌平面阻滞联合舒芬太尼PCIA在阑尾切除术后镇痛中的比较[J]. 临床麻醉学杂志, 2017, 33(10): 984-986.
[8]	Öksüz G, Bilal B, Gürkan Y, et al. Quadratuslumborum block versus transversusabdominis plane block in children undergoing low abdominal surgery: a randomized controlled trial[J]. RegAnesth Pain Med, 2017, 42(5): 674-679.
[9]	Blanco R, Ansari T, Riad W, et al. Quadratuslumborum block versus transversusabdominis plane block for postoperative pain after cesarean delivery: a randomized controlled trial[J]. Reg Anesth Pain Med, 2016, 41(6): 757-762.
[10]	Verma K, Malawat A, Jethava D, et al. Comparison of transversusabdominis plane block and quadratuslumborum block for post-caesarean section analgesia: a randomised clinical trial[J]. Indian J Anaesth, 2019, 63(10): 820-826.
[11]	Murouchi T, Iwasaki S, Yamakage M. Quadratuslumborum block: analgesic effects and chronological ropivacaine concentrations after laparoscopic surgery[J]. RegAnesth Pain Med, 2016, 41(2): 146-150.
[12]	İpek CB, Kara D, Yılmaz S, et al. Comparison of ultrasound-guided transversusabdominis plane block, quadratuslumborum block, and caudal epidural block for perioperative analgesia in pediatric lower abdominal surgery[J]. Turk J Med Sci, 2019, 49(5): 1395-1402.
[13]	王健. 超声引导下腰方肌阻滞[J]. 岭南现代临床外科, 2017, 17(5): 604-608.
[14]	Ueshima H, Otake H, Lin JA. Ultrasound-guided quadratuslumborum block: an updated review of anatomy and techniques[J]. Biomed Res Int, 2017, 2017: 2752876.
[15]	Dam M, Moriggl B, Hansen CK, et al. The pathway of injectate spread with the transmuscularquadratuslumborum block: a cadaver study[J]. Anesth Analg, 2017, 125(1): 303-312.
[16]	Elsharkawy H, El-Boghdadly K, Kolli S, et al. Injectate spread following anterior sub-costal and posterior approaches to the quadratuslumborum block: a comparative cadaveric study[J]. Eur J Anaesthesiol, 2017, 34(9): 587-595.
[17]	Mirra A, von Rotz A, Schmidhalter M, et al. Ultrasound-guided lateral and subcostal transversusabdominis plane block in calves: a cadaveric study[J]. Vet Anaesth Analg, 2018, 45(3): 384-391.
[18]	李纯青. 腰方肌阻滞的临床应用进展[J]. 临床麻醉学杂志, 2018, 34(6): 616-619.
[19]	Wikner M. Unexpected motor weakness following quadratus lumborum block for gynaecological laparoscopy[J]. Anaesthesia, 2017, 72(2): 230-232.

状态	组别	例数	拔管时	术后2 h	术后4 h	术后8 h	术后12 h	术后24 h	术后48 h
静息	Q组	42	0(0,0)	0(0,0)	1(0,1)	1(1,1)	1(1,1)^a	1(1,2)^a	2(1,2)^a
静息	T组	42	0(0,1)	0(0,1)	1(1,2)	1(1,1)	2(1,2)	3(2,3)	2(2,3)
运动	Q组	42	0(0,0)	0(0,0)	0(0,1)	1(1,1)	1(1,1)^a	1(1,1)^a	2(1,2)^a
运动	T组	42	0(0,0)	0(0,1)	1(0,1)	1(1,1)	2(2,2)	3(3,4)	3(3,4)

状态	组别	例数	拔管时	术后2 h	术后4 h	术后8 h	术后12 h	术后24 h	术后48 h
静息	Q组	42	0(0,0)	0(0,0)	1(0,1)	1(1,1)	1(1,1)^a	1(1,2)^a	2(1,2)^a
静息	T组	42	0(0,1)	0(0,1)	1(1,2)	1(1,1)	2(1,2)	3(2,3)	2(2,3)
运动	Q组	42	0(0,0)	0(0,0)	0(0,1)	1(1,1)	1(1,1)^a	1(1,1)^a	2(1,2)^a
运动	T组	42	0(0,0)	0(0,1)	1(0,1)	1(1,1)	2(2,2)	3(3,4)	3(3,4)

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