Subcostal Anterior Quadratus Lumborum Block Versus Epidural Block for Analgesia in Open Nephrectomy: A Randomized Clinical Trial
| Autor: | Wael Ali Sakr Esa, Sanchit Ahuja, Sean DeGrande, Dilara Khoshknabi, Guangmei Mao, Loran Mounir Soliman, Mohammad Zafeer Khan, Alparslan Turan, Hesham Elsharkawy, Kamal Maheshwari, Daniel I. Sessler, Syed Shahmeer Raza, Sabry Ayad |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Pain Threshold Time Factors medicine.drug_class medicine.medical_treatment Nephrectomy law.invention Pacu 03 medical and health sciences 0302 clinical medicine Randomized controlled trial 030202 anesthesiology law Threshold of pain medicine Antiemetic Humans Aged Ohio Pain Measurement Pain Postoperative biology business.industry Nerve Block Middle Aged biology.organism_classification Confidence interval Analgesia Epidural Analgesics Opioid Anesthesiology and Pain Medicine Treatment Outcome Opioid Anesthesia Nerve block Female business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Anesthesia and analgesia. 132(4) |
| ISSN: | 1526-7598 |
| Popis: | Background Epidural block are often used for analgesia after open nephrectomy surgery. Subcostal anterior quadratus lumborum block may be an alternative. We therefore tested the hypothesis that the continuous subcostal anterior quadratus lumborum block is noninferior to epidural block for analgesia in patients having open partial nephrectomies. Methods Adults having open partial nephrectomies were randomly allocated to epidural or unilateral subcostal anterior quadratus lumborum block. The joint primary outcomes were opioid consumption measured in morphine equivalents and pain measured on a numeric rating scale (0-10) from postanesthesia care unit (PACU) until 72 hours after surgery. The noninferiority deltas were 30% for opioid consumption and 1 point on a 0-10 scale for pain. Secondary outcomes included patient global assessment of pain management on the third postoperative day, the number of antiemetic medication doses through the third postoperative day, duration of PACU stay, and postoperative duration of hospitalization. Results Twenty-six patients were randomized to anterior quadratus lumborum block and 29 to epidural analgesia. Neither pain scores nor opioid consumption in the quadratus lumborum patients were noninferior to epidural analgesia. At 72 hours, mean ± standard deviation pain scores in subcoastal anterior quadratus lumborum block and epidural group were 4.7 ± 1.8 and 4.1 ± 1.7, with an estimated difference in pain scores of 0.62 (95% confidence interval [CI], 0.74-1.99; noninferiority P = .21). The median [Q1, Q3] opioid consumption was more than doubled in quadratus lumborum patients at 70 mg [43, 125] versus 30 mg [18, 75] in the epidural group with an estimated ratio of geometric means of 1.69 (95% CI, 0.66-4.33; noninferiority P = .80). Patient global assessment and duration of PACU and hospital stays did not differ significantly in the 2 groups. Conclusions We were unable to show that subcostal anterior quadratus lumborum block are noninferior to epidural analgesia in terms of pain scores and opioid consumption for open partial nephrectomies. Effectiveness of novel blocks should be rigorously tested in specific surgical setting before widespread adoption. |
| Databáze: | OpenAIRE |
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