Skip to main content
SpringerLink
Log in

Continuous basal infusion versus programmed intermittent bolus for quadratus lumborum block after laparoscopic colorectal surgery: a randomized-controlled, double-blind study

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Background

Quadratus lumborum block (QLB) has recently attracted attention as a part of multimodal analgesia after abdominal surgery. It has been shown that programmed intermittent boluses of local anesthetic can produce better analgesia and wider sensory blockade compared with continuous basal infusion with some peripheral nerve blocks. The present study was conducted to see if this theory holds true for QLB in patients undergoing laparoscopic colorectal surgery.

Methods

Fifty patients undergoing laparoscopic colorectal surgery were divided into 2 groups to receive continuous basal infusion (group C) or programmed intermittent boluses (group PIB) of local anesthetic. After surgery, patients received the posterior approach to QLB and a catheter was introduced bilaterally. Patients in group C received a continuous infusion of 0.15% levobupivacaine at 3 ml/h, and those in group PIB received a bolus of 12 ml every 4 h. All patients received intravenous patient-controlled analgesia using fentanyl. Measurements were taken for cumulative fentanyl consumption, pain scores, cutaneous sensory blockade, analgesic requirements, and adverse events for 46 h.

Results

The primary outcome of cumulative fentanyl consumption at 22 h showed no significant difference between the groups [group C: 11.9 (11.2–15.5) µg/kg (median (interquartile range)) and group PIB: 12.3 (11.6–15.3), p = 0.473]. Pain scores, demands for rescue analgesics, and spread of cutaneous sensory blockade were similar for the two groups.

Conclusion

Programmed intermittent boluses of local anesthetic for continuous QLB did not produce better analgesia or wider sensory blockade compared with continuous basal infusion in patients undergoing laparoscopic colorectal surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, Hill AG, Soop M, de Boer HD, Urman RD, Chang GJ, Fichera A, Kessler H, Grass F, Whang EE, Fawcett WJ, Carli F, Lobo DN, Rollins KE, Balfour A, Baldini G, Riedel B, Ljungqvist O. Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS®) society recommendations: 2018. World J Surg. 2019;43:659–95.

    Article  CAS  PubMed  Google Scholar 

  2. Oh TK, Yim J, Kim J, Eom W, Lee SA, Park SC, Oh JH, Park JW, Park B, Kim DH. Effects of preoperative ultrasound-guided transversus abdominis plane block on pain after laparoscopic surgery for colorectal cancer: a double-blind randomized controlled trial. Surg Endosc. 2017;31:127–34.

    Article  PubMed  Google Scholar 

  3. Blanco R, Ansari T, Riad W, Shetty N. Quadratus lumborum block versus transversus abdominis plane block for postoperative pain after cesarean delivery: a randomized controlled trial. Reg Anesth Pain Med. 2016;41:757–62.

    Article  CAS  PubMed  Google Scholar 

  4. Yousef NK. Quadratus lumborum block versus transversus abdominis plane block in patients undergoing total abdominal hysterectomy: a randomized prospective controlled trial. Anesth Essays Res. 2018;12:742–7.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Murouchi T, Iwasaki S, Yamakage M. Quadratus lumborum block: analgesic effects and chronological ropivacaine concentrations after laparoscopic surgery. Reg Anesth Pain Med. 2016;41:146–50.

    Article  CAS  PubMed  Google Scholar 

  6. Ishio J, Komasawa N, Kido H, Minami T. Evaluation of ultrasound-guided posterior quadratus lumborum block for postoperative analgesia after laparoscopic gynecologic surgery. J Clin Anesth. 2017;41:1–4.

    Article  PubMed  Google Scholar 

  7. Öksüz G, Bilal B, Gürkan Y, Urfalioǧlu A, Arslan M, Gişi G, Öksüz H. Quadratus lumborum block versus transversus abdominis plane block in children undergoing low abdominal surgery: a randomized controlled trial. Reg Anesth Pain Med. 2017;42:674–9.

    Article  PubMed  Google Scholar 

  8. Kumar GD, Gnanasekar N, Kurhekar P, Prasad TK. A comparative study of transversus abdominis plane block versus quadratus lumborum block for postoperative analgesia following lower abdominal surgeries: a prospective double-blinded Study. Anesth Essays Res. 2018;12:919–23.

    PubMed  PubMed Central  Google Scholar 

  9. Kadam VR. Ultrasound guided quadratus lumborum block or posterior transversus abdominis plane block catheter infusion as a postoperative analgesic technique for abdominal surgery. J Anaesthesiol Clin Pharmacol. 2015. https://doi.org/10.4103/0970-9185.150575.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Shaaban M, Esa WAIS, Maheshwari K, Elsharkawy H, Soliman LM. Bilateral continuous quadratus lumborum block for acute postoperative abdominal pain as a rescue after opioid-induced respiratory depression. A A Case Rep. 2015;5:107–11.

    Article  PubMed  Google Scholar 

  11. Chakraborty A, Goswami J, Patro V. Ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a pediatric patient. A A Case Rep. 2015;4:34–6.

    Article  PubMed  Google Scholar 

  12. Warusawitharana C, Basar SHMA, Jackson BL, Niraj G. Ultrasound guided continuous transmuscular quadratus lumborum analgesia for open renal surgery: a case series. J Clin Anesth. 2017;42:100–1.

    Article  PubMed  Google Scholar 

  13. Graça R, Miguelez P, Cardoso JM, Sá M, Brandão J, Pinheiro C, Machado D. Continuous quadratus lumborum type II block in partial nephrectomy. Rev Bras Anestesiol. 2018;68:653–6.

    Article  Google Scholar 

  14. Zhu Q, Li L, Yang Z, Shen J, Zhu R, Wen Y, Cai W, Liu L. Ultrasound guided continuous quadratus lumborum block hastened recovery in patients undergoing open liver resection: a randomized controlled, open-label trial. BMC Anesthesiol. 2019. https://doi.org/10.1186/s12871-019-0692-z.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Xu J, Zhou J, Xiao H, Pan S, Liu J, Shang Y, Yao S. A systematic review and meta-analysis comparing programmed intermittent bolus and continuous infusion as the background infusion for parturient-controlled epidural analgesia. Sci Rep. 2019. https://doi.org/10.1038/s41598-019-39248-5.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bullingham A, Liang S, Edmonds E, Mathur S, Sharma S. Continuous epidural infusion vs programmed intermittent epidural bolus for labour analgesia: a prospective, controlled, before-and-after cohort study of labour outcomes. Br J Anaesth. 2018;121:432–7.

    Article  CAS  PubMed  Google Scholar 

  17. Taboada M, Rodríguez J, Bermudez M, Valiño C, Ulloa B, Aneiros F, Gude F, Cortés J, Alvarez J, Atanassoff PG. A “new” automated bolus technique for continuous popliteal block: a prospective, randomized comparison with a continuous infusion technique. Anesth Analg. 2008;107:1433–7.

    Article  PubMed  Google Scholar 

  18. Hillegass MG, Field LC, Stewart SR, Borckardt JJ, Dong L, Kotlowski PE, Demos HA, Del Schutte H, Reeves ST. The efficacy of automated intermittent boluses for continuous femoral nerve block: a prospective, randomized comparison to continuous infusions. J Clin Anesth. 2013;25:281–8.

    Article  CAS  PubMed  Google Scholar 

  19. Chen L, Wu Y, Cai Y, Ye Y, Li L, Xia Y, Papadimos TJ, Xu X, Wang Q. Comparison of programmed intermittent bolus infusion and continuous infusion for postoperative patient-controlled analgesia with thoracic paravertebral block catheter: a randomized, double-blind, controlled trial. Reg Anesth Pain Med. 2019;44:240–5.

    Article  PubMed  Google Scholar 

  20. Hida K, Murata H, Ichinomiya T, Inoue H, Sato S, Hara T. Effects of programmed intermittent thoracic paravertebral bolus of levobupivacaine on the spread of sensory block: a randomized, controlled, double-blind study. Reg Anesth Pain Med. 2019;44:326–32.

    PubMed  Google Scholar 

  21. Taketa Y, Irisawa Y, Fujitani T. Programmed intermittent bolus infusion versus continuous infusion of 0.2% levobupivacaine after ultrasound-guided thoracic paravertebral block for video-assisted thoracoscopic surgery: a randomised controlled trial. Eur J Anaesthesiol. 2019;36:272–8.

    Article  CAS  PubMed  Google Scholar 

  22. Aoyama Y, Sakura S, Abe S, Wada M, Saito Y. Analgesic effects and distribution of cutaneous sensory blockade of quadratus lumborum block type 2 and posterior transversus abdominis plane block: an observational comparative study. Korean J Anesthesiol. 2020. https://doi.org/10.4097/kja.19404.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kanai A, Koiso S, Hoka S. Comparison of analgesia induced by continuous epidural infusion of plain 1% lidocaine and 1% lidocaine prepared by dilution of 2% lidocaine with the same volume of saline. J Clin Anesth. 2007;19:534–8.

    Article  CAS  PubMed  Google Scholar 

  24. Taboada M, Rodríguez J, Bermudez M, Amor M, Ulloa B, Aneiros F, Sebate S, Cortés J, Alvarez J, Atanassoff PG. Comparison of continuous infusion versus automated bolus for postoperative patient-controlled analgesia with popliteal sciatic nerve catheters. Anesthesiology. 2009;110:150–4.

    Article  PubMed  Google Scholar 

  25. Kadam VR, Van Wijk RM, Moran JL, Ganesh S, Kumar A, Sethi R, Williams P. Continuous transversus abdominis plane block vs intermittent bolus for analgesia after abdominal surgery: a randomized trial. J Pain Res. 2017. https://doi.org/10.2147/JPR.S132891.

    Article  Google Scholar 

  26. Holmes R, Smith SR, Carroll R, Holz P, Mehrotra R, Pockney P. Randomized clinical trial to assess the ideal mode of delivery for local anaesthetic abdominal wall blocks. ANZ J Surg. 2018. https://doi.org/10.1111/ans.14317.

    Article  PubMed  Google Scholar 

  27. Khatibi B, Said ET, Sztain JF, Monahan AM, Gabriel RA, Furnish TJ, Tran JT, Donohue MC, Ilfeld BM. Continuous transversus abdominis plane nerve blocks: does varying local anesthetic delivery method-automatic repeated bolus versus continuous basal infusion-influence the extent of sensation to cold?: a randomized, triple-masked, crossover study in volunteers. Anesth Analg. 2017;124:1298–303.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Elsharkawy H, El-Boghdadly K, Kolli S, Esa WAS, DeGrande S, Soliman LM, Drake RL. Injectate spread following anterior sub-costal and posterior approaches to the quadratus lumborum block: a comparative cadaveric study. Eur J Anaesthesiol. 2017;34:587–95.

    Article  PubMed  Google Scholar 

  29. Tamura T, Yokota S, Ito S, Shibata Y, Nishiwaki K. Local anesthetic spread into the paravertebral space with two types of quadratus lumborum blocks: a crossover volunteer study. J Anesth. 2019;33:26–322.

    Article  PubMed  Google Scholar 

  30. Shin HJ, Kim ST, Yim KH, Lee HS, Sim JH, Shin YD. Preemptive analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing gynecologic surgery via a transverse lower abdominal skin incision. Korean J Anesthesiol. 2011;61:413–8.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

None.

Funding

This work was supported by Shimane University, Department of Anesthesiology and Smiths Medical ASD Inc.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo City, Shimane, 693-8501, Japan

    Yuki Aoyama, Shinichi Sakura, Aumjit Wittayapairoj, Shoko Abe, Saki Tadenuma & Yoji Saito

  2. Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Road, Nai Mueang Subdistrict, Khon Kaen, Thailand

    Aumjit Wittayapairoj

Authors
  1. Yuki Aoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shinichi Sakura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aumjit Wittayapairoj
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shoko Abe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Saki Tadenuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoji Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by YA, SS, and SA. The first draft of the manuscript was written by YA and SS, and all authors commented on the manuscript.

Corresponding author

Correspondence to Shinichi Sakura.

Ethics declarations

Conflict of interest

Smiths Medical ASD Inc. provided research funding, infusion pumps, and tubing, but the company had no involvement in the study design, data collection, analysis, interpretation of the data, or preparation of the manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aoyama, Y., Sakura, S., Wittayapairoj, A. et al. Continuous basal infusion versus programmed intermittent bolus for quadratus lumborum block after laparoscopic colorectal surgery: a randomized-controlled, double-blind study. J Anesth 34, 642–649 (2020). https://doi.org/10.1007/s00540-020-02791-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-020-02791-x

Keywords

Search

Navigation