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Comparison of types 2 and 3 quadratus lumborum muscle blocks

Open inguinal hernia surgery in patients with spinal anesthesia

Vergleich des M.-quadratus-lumborum-Blocks Typ 2 und 3

Offene Leistenhernienoperation unter Spinalanästhesie

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Abstract

Objective

The efficacy of quadratus lumborum muscle block (QLB) in abdominal surgery is known; however, the efficacy of different QLB types is unclear. The objective of this study was to investigate the effects of ultrasound-guided QLB type 2 and type 3 on postoperative opioid consumption and pain scores in patients undergoing inguinal hernia surgery.

Material and methods

In this study 60 patients undergoing open inguinal hernia surgery were randomly assigned to 3 groups. Group QLB2 received ultrasound-guided QLB type 2 and group QLB3 received ultrasound-guided QLB type 3 with 0.25% 20 mL bupivacaine. In the control group (group C) no intervention was performed. Postoperative analgesia was performed intravenously with 1000 mg paracetamol every 6 h and patient-controlled analgesia with fentanyl. Postoperative visual analog scale scores (VAS), opioid consumption, and first analgesic requirement time were evaluated.

Results

Fentanyl consumption was significantly higher in group C compared to the other groups at all time intervals (p < 0.05). Fentanyl consumption was significantly higher in group QLB2 compared to QLB3 at the 4–8 h, 8–24 h, and total 24 h. Passive VAS 4h and 8 h, active VAS 4h, 8h, and 12 h were significantly lower in group QLB3 compared to QLB2 (p < 0.05). The first analgesic time was significantly later in group QLB2 compared to group C (280.52 ± 89.20 min and 183.75 ± 42.79 min, respectively) and even later in group QLB3 compared to the other two groups (463.42 ± 142.43 min, p < 0.05).

Conclusion

The use of QLB2 and QLB3 decreased postoperative opioid consumption and pain scores in patients undergoing inguinal hernia surgery. Furthermore, QLB3 provided more effective and longer lasting postoperative analgesia and lower opioid consumption compared to QLB2.

Zusammenfassung

Ziel

Die Wirksamkeit des M.-quadratus-lumborum-Blocks (QLB) in der Bauchchirurgie ist bekannt, die Wirksamkeit verschiedener QLB-Typen jedoch unklar. Das Ziel dieser Studie war es, die Auswirkungen von ultraschallgesteuerten QLB-Typen 2 und 3 auf den postoperativen Opioidverbrauch und die Schmerzscores bei Patienten, die sich einer Leistenhernienoperation unterziehen, zu untersuchen.

Material und Methoden

In dieser Studie wurden 60 Patienten, die sich einer offenen Leistenhernienoperation unterzogen, nach dem Zufallsprinzip in 3 Gruppen eingeteilt. Die Gruppe QLB2 erhielt den ultraschallgesteuerten QLB-Typ 2 und die Gruppe QLB3 erhielt den ultraschallgesteuerten QLB-Typ 3 mit 20 ml Bupivacain 0,25 %. In der Kontrollgruppe (Gruppe C) wurde keine Intervention durchgeführt. Es erfolgten eine postoperative Analgesie intravenös mit 1000 mg Paracetamol alle 6 h und eine patientenkontrollierte Analgesie mit Fentanyl. Die postoperativen Werte der visuellen Analogskala (VAS), der Opioidkonsum und die Zeit des ersten Schmerzmittelbedarfs wurden ausgewertet.

Ergebnisse

Der Fentanylverbrauch war in Gruppe C in allen Zeitabständen signifikant höher als in den anderen Gruppen (p < 0,05). Der Fentanylverbrauch war in der Gruppe QLB2 im Vergleich zu QLB3 bei 4–8 h, 8–24 h und insgesamt 24 h signifikant höher. Die passive VAS 4 h und 8 h sowie die aktive VAS 4 h, 8 h und 12 h waren in der Gruppe QLB3 im Vergleich zu QLB2 signifikant niedriger (p < 0,05). Die erste Analgetikumzeit war in der Gruppe QLB2 im Vergleich zur Gruppe C signifikant später (280,52 ± 89,20 und 183,75 ± 42,79) und noch später in der Gruppe QLB3 im Vergleich zu den beiden anderen Gruppen (463,42 ± 142,43; p < 0,05).

Schlussfolgerung

Die Anwendung von QLB2 und QLB3 führte zu einer Verringerung des postoperativen Opioidverbrauchs und der Schmerzwerte bei Patienten, die sich einer Leistenhernienoperation unterziehen. Darüber hinaus führte der QLB3 zu einer wirksameren und länger anhaltenden postoperativen Analgesie und einem geringeren Opioidverbrauch im Vergleich zum QLB2.

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Authors and Affiliations

  1. Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey

    O. Bagbanci, H. Kursad, A. M. Yayik MD, E. O. Ahiskalioglu, M. E. Aydin & A. Ahiskalioglu

  2. Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, 25240, Erzurum, Turkey

    A. M. Yayik MD, M. E. Aydin & A. Ahiskalioglu

  3. Department of General Surgery, Ataturk University School of Medicine, Erzurum, Turkey

    E. Karadeniz

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  1. O. Bagbanci
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  2. H. Kursad
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  3. A. M. Yayik MD
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  4. E. O. Ahiskalioglu
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  5. M. E. Aydin
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Correspondence to A. M. Yayik MD.

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Conflict of interest

O. Bagbancı, H. Kürşad, A.M. Yayik, E.O. Ahıskalıoğlu, M.E. Aydın, A. Ahıskalıoğlu and E. Karadeniz declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Bagbanci, O., Kursad, H., Yayik, A.M. et al. Comparison of types 2 and 3 quadratus lumborum muscle blocks. Anaesthesist 69, 397–403 (2020). https://doi.org/10.1007/s00101-020-00766-x

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  • DOI: https://doi.org/10.1007/s00101-020-00766-x

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