Proof of concept study of the posterior quadratus lumborum block for laparoscopic myomectomy: A randomized controlled trial

In the United States, 65,000 myomectomies are performed annually to treat uterine fibroids. The quadratus lumborum block (QLB) is an effective block for laparoscopic pelvic surgery, urologic surgery, hip surgery and cesarean sections, with limited data for laparoscopic myomectomies. We evaluated the posterior QLB in reducing MME consumption and numeric rating scale (NRS) pain scores in patients undergoing laparoscopic myomectomies. Twenty-two subjects were enrolled in this single-center, randomized, controlled study between March 28, 2019 and June 16, 2020 and were randomized to either the QLB or control group. Seven subjects were excluded from the final analysis, 5 after being lost to follow-op and 2 for not meeting the inclusion criteria. Recipients in the QLB group received bilateral posterior QLBs, with 30 mL of 0.25% ropivacaine per injection. The primary outcome of MME use at 24 hours was not significant between the QLB group and the control group (23.3 ± 8.5 mg vs. 25.7 ± 14.4 mg, p = 0.859). The secondary outcome of NRS pain scores was also not significant between groups (p > 0.05). While this study did not provide evidence that QLB may be useful in reducing opioid consumption or pain scores in patients undergoing laparoscopic myomectomies, further studies with a larger sample size will be valuable to determine the effectiveness of this block for laparoscopic myomectomy.

Use of quadratus lumborum block in gynecologic procedures

OBJECTIVE

Adequately managing post-operative pain is essential for improving patient outcomes and reducing post-operative complications. The quadratus lumborum (QL) block is a truncal nerve block technique that was recently developed to provide analgesia during abdominal and hip surgical procedures. While many studies have shown the outstanding analgesic effect of QL blocks, this technique is not well-known or commonly used in gynecologic procedures.

FINDINGS

This narrative review describes evidence in current literature on the safety and effectiveness of QL blocks when used for gynecologic procedures. The studies show that including QL blocks as part of the approach to managing post-operative pain in gynecologic patients can reduce post-operative pain, reduce analgesic consumption, and lengthen time to first analgesic. They also suggest that QL blocks are more effective at managing post-operative pain and have a lower risk for systemic toxicity compared with transversus abdominis plane blocks.

SUMMARY

According to current randomized controlled trials, QL blocks have been shown to be effective in managing post-operative pain after gynecologic surgical procedures. Further studies on effectiveness in different procedures, adjuvants, and optimum dosing of local anesthetic are needed to determine the best application of QL blocks in gynecologic procedures.

Intelligent Medical Assessment of the Impact of Anesthesia and Sedation Depth on Cognitive Function after Gynecological Laparoscopic Surgery

In recent years, the research on post operational cognitive dysfunction (POCD) has received increasing attention. Some patients may experience complications such as mental disorder and memory impairment after gynecological laparoscopic surgery, which are cognitive, social, and personality issues of postoperative patients. This article divided patients after gynecological laparoscopic surgery into three groups based on different BIS (biological index) ranges. Before clinical use, artificial intelligence was used to sort out patients' complete history records, physical examination and analyze laboratory examination results, so as to determine the anesthetic dose and depth and reduce the incidence of accidents during surgery. This article adopted a combination of midazolam propofol radiocuronium bromide general anesthesia to adjust blood targeted concentration and maintain the depth of general anesthesia for patients. Using POCD as a starting point, the occurrence of POCD after gynecological laparoscopic surgery was evaluated through preoperative and postoperative neuropsychological measurements on the 14th day, as well as MMSE (Minimal State Examination) scores, and the impact of different anesthesia depths on POCD was also explored, which can provide a theoretical basis for the prevention and treatment of POCD. The MMSE score of Group A patients on the day before anesthesia was 23.9, while the MMSE score of Group B patients on the day before anesthesia was 23.8. The application of intelligent medicine in the study of the impact of anesthesia and sedation depth on gynecological laparoscopic surgery can improve the safety of surgery and the quality of life of patients, and has an important promoting role in clinical practice. The innovation of the research in this paper lies in the use of intelligent medical technology, through neuropsychological testing and MMSE scoring, in-depth analysis of the relationship between anesthesia depth and POCD.Combined anesthesia with midazolam and propofol was used, and the depth of anesthesia was precisely adjusted according to the BIS value.The study found that shallow anesthesia (low BIS value) may reduce the incidence of POCD, which provides theoretical and practical guidance for optimizing anesthesia strategies.

Effect of Preoperative Bilateral Ultrasound-Guided Quadratus Lumborum Nerve Block on Quality of Recovery After Minimally Invasive Hysterectomy in an Enhanced Recovery After Surgery (ERAS) Setting

STUDY OBJECTIVE

To assess the effect of preoperative bilateral ultrasound-guided quadratus lumborum nerve block (QLB) on quality of recovery after minimally invasive hysterectomy, in an enhanced recovery after surgery setting.

DESIGN

Randomized, controlled, double-blinded trial (Canadian Task Force level I).

SETTING

University-affiliated tertiary medical center.

PATIENTS

All women undergoing an elective robotic or laparoscopic hysterectomy. Women with chronic pain, chronic anticoagulation, and body mass index >50 kg/m2 were excluded.

INTERVENTION

Patients were randomized with a 1:1 allocation, to one of the following 2 arms, and stratified based on robotic versus laparoscopic approach. 1. QLB: QLB (bupivacaine) + sham local trocar sites infiltration (normal saline) 2. Local infiltration: sham QLB (normal saline) + local infiltration (bupivacaine) MEASUREMENTS AND MAIN RESULTS: The primary outcome was defined as the quality of recovery score based on the validated questionnaire Quality of Recovery, completed 24 hours postoperatively. Secondary outcomes included dynamic pain scores, accumulated opioid consumption up to 24 hours, postoperative nausea and vomiting, surgical complications, length of hospital stay, time to first pain medication administration in the postanesthesia care unit, and adverse events. A total of 76 women were included in the study. Demographic characteristics were similar in both groups. Median age was 44 years (interquartile range 39-50), 47% of the participants were African American, and mean body mass index was 32.8 kg/m2 (standard deviation [SD] 8.1). The mean Quality of Recovery score was 179.1 (SD ± 10.3) in the QLB and 175.6 (SD ± 9.7) for the local anesthesia group (p = .072). All secondary outcomes were comparable between groups.

CONCLUSIONS

QLBs do not significantly improve quality of recovery after elective robotic or laparoscopic hysterectomy compared with local anesthetic port site infiltration.

Ultrasound-guided quadratus lumborum block provided more effective analgesia for children undergoing lower abdominal laparoscopic surgery: a randomized clinical trial

BACKGROUND

Postoperative pain treatment for pediatrics is often inadequate and the evidence of pediatric postoperative analgesia is scarce. To our knowledge, no report regarding the comparison among caudal block, transversus abdominis plane (TAP) block and quadratus lumborum (QL) block for children undergoing lower abdominal laparoscopic surgery was found at present. Thus this trial aimed to compare the efficacies of them for children undergoing lower abdominal laparoscopic surgery.

METHODS

One hundred and eighty children aged from 1 to 12 years undergoing lower abdominal laparoscopic surgery were included and randomized to receive caudal block, TAP block or QL block. The primary outcome was the Face, Legs, Activity, Cry, and Consolability (FLACC) score at 30 min, 1 h, 4 h, 8 h, 12 h, and 24 h and tramadol consumption during first 24 h postoperatively. Secondary outcomes included the number of children received tramadol, time to first tramadol request, parents' satisfaction and postoperative adverse reactions.

RESULTS

The QLB group had lower postoperative FLACC scores at 8 h (median difference - 0.43, P = 0.03) than the Caudal group and at 4 h (median difference - 0.6, P = 0.001) and 8 h (median difference - 0.43, P = 0.03) than the TAPB group. The tramadol consumption was lower in the QLB group (28.43 ± 6.55) than the TAPB group (37.17 ± 6.12, P = 0.023). Although the number of children received tramadol did not differ among the three groups, the time to first tramadol request was longer in the QLB group (7.20 ± 0.79) than the caudal group (8.42 ± 0.61, P = 0.008). No statistical difference was observed concerning other secondary outcomes.

CONCLUSIONS

QLB produced more effective postoperative analgesia for children undergoing laparoscopic abdominal surgery compared with the TAPB and caudal block.

Methods and timing in the assessment of postoperative recovery: a scoping review

BACKGROUND

There is no consensus about the type of instrument with which to assess postoperative recovery or the time points when assessments are most appropriate. It is also unclear whether instruments measure the four dimensions of postoperative recovery, that is physical, psychological, social, and habitual recovery. This scoping review had three objectives: (1) to identify and describe instruments used in clinical trials to assess postoperative recovery; (2) to determine how, when, and the number of times postoperative recovery was measured; and (3) to explore whether the four dimensions of postoperative recovery are represented in the identified instruments.

METHODS

A literature search was conducted in CINAHL, MEDLINE, and Web of Science. The search terms were related to three search strands: postoperative recovery, instrument, and clinical trials. The limits were English language and publication January 2010 to November 2021. In total, 5015 studies were identified.

RESULTS

A total of 198 studies were included in the results. We identified 20 instruments measuring postoperative recovery. Different versions of Quality of Recovery represented 81.8% of the included instruments. Postoperative recovery was often assessed at one time point (47.2%) and most often on postoperative day 1 (81.5%). Thirteen instruments had items covering all four dimensions of postoperative recovery.

CONCLUSIONS

Assessing recovery is important to evaluate and improve perioperative care. We emphasise the importance of choosing the right instrument for the concept studied and, if postoperative recovery is of interest, of assessing more than once. Ideally, instruments should include all four dimensions to cover the whole recovery process.

Relationship between the Use of Fentanyl-Based Intravenous Patient-Controlled Analgesia and Clinically Significant Events in Laparoscopic Gynecological Surgery: A Single-Center Retrospective Cohort Study

Background: This study examined the relationship between the use of fentanyl-based intravenous patient-controlled analgesia (ivPCA) and the incidence of a clinically significant event (CSE), while considering both the analgesic effects and side effects in laparoscopic gynecological surgery. Methods: This study included 816 patients undergoing laparoscopic gynecological surgery under general anesthesia at Kyoto University Hospital between 2012 and 2018. The primary exposure was the use of fentanyl-based ivPCA. We defined an outcome measure—CSE—that integrates severe wound pain and vomiting assumed to negatively affect patient recovery. We performed multivariable logistic regression analysis to assess the independent relationship between ivPCA use and CSE. Results: Multivariable logistic regression analysis revealed that fentanyl-based ivPCA was independently associated with increased CSE (adjusted odds ratio (95% confidence interval): 1.80 (1.24−2.61), p = 0.002). Use of ivPCA was associated with a reduced incidence of postoperative severe wound pain (adjusted odds ratio (95% confidence interval): 0.50 (0.27−0.90), p = 0.022), but was also associated with an increased incidence of vomiting (adjusted odds ratio (95% confidence interval): 2.65 (1.79−3.92), p < 0.001). Conclusion: The use of fentanyl-based ivPCA in laparoscopic gynecological surgery is associated with increased CSE.

Ultrasound-Guided Quadratus Lumborum Block Enhances the Quality of Recovery after Gastrointestinal Surgery: A Randomized Controlled Trial

Background

Quadratus lumborum block (QLB) has been used to reduce postoperative acute pain and opioid consumption. However, the efficacy of QLB on the quality of recovery (QoR) after gastrointestinal surgery has not been established. The aim of this study was to evaluate the ability of QLB to enhance the postoperative QoR in patients undergoing open gastrointestinal surgery.

Methods

Eighty-four patients undergoing open gastrointestinal surgery were randomized to receive ultrasound-guided QLB with either 20 ml of 0.375% ropivacaine or saline. The primary outcome was the QoR-15 score at 24 h after surgery. The secondary outcomes were the postoperative pain intensity, opioid consumption, the incidence of nausea, vomiting, and chronic pain.

Results

The global QoR-15 score at 24 h postoperatively was significantly higher in the QLB group than in the control group (mean difference: 16.9; 95% CI: 11.9–21.9). Additionally, the QoR-15 scores for five dimensions were significantly higher in the QLB group than in the control group. The cumulative oxycodone consumption was significantly lower in the QLB group during 0–6, 6–24, 0–24, 24–48, and 0–48 h postoperatively than in the control group. At rest or during coughing, the pain verbal rating scale scores were significantly lower at 1, 3, 6, 12, and 24 h after surgery in the QLB group than in the control group. The incidence of postoperative nausea was significantly different between the groups, but postoperative vomiting was not.

Conclusion

Single-injection posteromedial QLB with ropivacaine enhanced the QoR at 48 h after surgery and improved analgesia during the early postoperative period in patients undergoing gastrointestinal surgery.

Ultrasound-Guided Posterior Quadratus Lumborum Block for Acute Postoperative Analgesia in Adult Patients: A Meta-Analysis of Randomized Controlled Trials

Objective

The quadratus lumborum block provides postoperative analgesia for patients undergoing abdominal surgery, although there are three common approaches to perform this block. The present meta-analysis investigated the effectiveness of posterior quadratus lumborum block (QLB2) after surgery.

Methods

PubMed, Embase, and the Cochrane Central Register were searched from inception to 26 August 2021 for randomized controlled trials that evaluated the analgesic efficacy of QLB2 vs control (placebo or no block). The primary outcomes were pain scores at 6 h, 12 h, and 24 h after surgery. The secondary outcomes were morphine consumption at 24 h after surgery and the postoperative complications.

Results

The present meta-analysis included 14 studies conducted with a total of 1001 patients. In comparison to control group, the QLB2 group presented significantly lower rest pain scores at 6 h (SMD -0.59; 95% CI: -1.05, -0.12; p = 0.01, I2 = 84%; GRADE = moderate), 12 h (SMD: -0.83; 95% CI: -1.47, -0.19; p = 0.01; I2 = 88%; GRADE = low), and 24 h (SMD: -0.37; 95% CI: -0.71, -0.03; p = 0.03; I2 = 80%; GRADE = moderate) after surgery. The dynamic pain scores were significantly reduced, compared to control, in the QLB2 group at 12 h (SMD: -0.93; 95% CI: -1.52, -0.33; p = 0.002; I2 = 83%; GRADE = low) and 24 h (SMD: -0.52; 95% CI: -0.93, -0.11; p = 0.01; I2 = 83%; GRADE = moderate) after surgery. In addition, the QLB2 group presented reduced postoperative opioid consumption at 24 h (SMD: -0.45; 95% CI: -0.86, -0.03; p = 0.03; I2 = 78%; GRADE = moderate). The subgroup analyses revealed that the analgesic benefit of QLB2 did not persist beyond 24 h when the patients were under spinal anesthesia.

Conclusion

Ultrasound-guided QLB2 could provide effective analgesia for patients under general anesthesia by decreasing the intensity of pain and opioid requirement when used within 24 h after abdominal surgery.

The Use of Peripheral Nerve Blockade in Laparoscopic and Robotic Surgery: Is There a Benefit?

PURPOSE OF REVIEW

The purpose of this review is to synthesize recent literature investigating the use of regional anesthesia for minimally invasive surgery.

RECENT FINDINGS

Recent studies investigating the use of newer peripheral nerve blocks such as erector spinae plane (ESP) and quadratus lumborum (QL) block are very limited. Evidence supporting the use of peripheral nerve blockade in laparoscopic or robotic surgery is very limited and of low-moderate quality. While transverse abdominal plane (TAP) block may decrease opioid and pain scores after laparoscopic cholecystectomy, bariatric surgery, and colorectal surgery, the benefit of the block in the presence of multimodal analgesia remains to be clarified. Unilateral paravertebral block may be beneficial for percutaneous nephrolithotomy. ESP and rectus sheath blockade may enhance analgesia in laparoscopic surgery, but the magnitude of this benefit may not be clinically relevant. Limited evidence supports the use of QL block in laparoscopic urologic surgery. There is insufficient recent evidence to support the use of TAP or QL block for laparoscopic gynecologic surgery.

Combined lumbar muscle block and perioperative comprehensive patient-controlled intravenous analgesia with butorphanol in gynecological endoscopic surgery

BACKGROUND

Laparoscopic surgery has become a common surgical approach for the clinical treatment of intra-abdominal lesions in recent years. We hypothesized that lumbar block with postoperative patient-controlled intravenous analgesia (PCIA) by butorphanol after gynecological surgery under general anesthesia would be more effective than PCIA by butorphanol alone.

AIM

To investigate the effect of lumbar block with PCIA by butorphanol after gynecological surgery under general anesthesia.

METHODS

This study assessed 120 women scheduled for laparoscopic surgery at our hospital between May 2017 and May 2020. They were divided using a random number table into a research group (those who received quadratus lumborum block combined with PCIA analgesia by butorphanol) and a control group (those who received only PCIA analgesia by butorphanol), with 60 patients in each group. Demographic factors, visual analog scale scores for pain, serum inflammatory markers, PCIA compressions, Ramsay scores, and adverse events were compared between groups using a t-test, analysis of variance, or χ² test, as appropriate.

RESULTS

There were no significant differences in demographic factors between groups (all P > 0.05). The visual analog scale scores of the research group in the resting state 12 h and 24 h postoperatively were significantly lower than those of the control group (P < 0.05). Two hours after surgery, there were no significant differences in the levels of serum tumor necrosis factor-α, interleukin (IL)-6, or IL-8 between groups (P > 0.05). The serum tumor necrosis factor-α levels of the research group 24 h postoperatively were significantly lower than those of the control group (P < 0.05). The levels of serum IL-6 and IL-8 in the study group 24 h and 48 h postoperatively were significantly lower than those in the control group (P < 0.05).

CONCLUSION

Lumbar block with PCIA with butorphanol after gynecological surgery under general anesthesia significantly improves the analgesic effect and reduces the degree of inflammation, instances of PCIA compression, and adverse reactions.

Evaluation of analgesic effects and safety of quadratus lumborum block in patients undergoing laparoscopic surgery: a meta-analysis of randomized controlled trials

INTRODUCTION

Recent years have witnessed the rapid expansion of quadratus lumborum block (QLB) technique in laparoscopic surgeries. However, inconsistent conclusions from latest studies prompted us to conduct present study to evaluate comprehensively the effects of QLB in patients undergoing laparoscopic surgery.

EVIDENCE ACQUISITION

Databases including PubMed, Embase, and Cochrane Library were searched from inception to March 2021 by us. Randomized controlled trials comparing QLB versus placebo or different block techniques were involved. Coprimary outcomes included number of patients requiring additional analgesia, opioids consumption and incidence of postoperative nausea/vomiting (PONV).

EVIDENCE SYNTHESIS

Data from 20 studies involving a total of 1,332 patients were acquired. Based on the current evidences, the results indicated that application of QLB was associated with less number of patients requiring additional analgesia (RR = 0.67, with 95% CI [0.49, 0.91]), reduced intraoperative opioid consumption (SMD - 0.97 with 95% CI [-1.48, -0.45]) and postoperative opioid consumption (SMD -19.12 with 95% CI [-34.83, -3.41]), and less incidence of postoperative nausea and vomiting (RR = 0.71, with 95% CI [0.58, 0.87]) compared to placebo. In addition, no significant intergroup (QLB vs different regional block techniques) differences were observed for most outcomes.

CONCLUSIONS

Current evidences exhibited several superiorities of QLB for patients in laparoscopic surgeries. Differences between QLB and some other block techniques in analgesic effects and PONV controlling effects were not significant. However, it calls for more high-quality evidences with large samples and trials with consistent evaluation scales for pain evaluation to draw more reliable conclusions.

The impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery: a randomized controlled trial

Background

Our objective was to evaluate the impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery.

Methods

One hundred forty female patients scheduled for laparoscopic gynecological surgery were enrolled in this prospective, randomized controlled trial. Participants were randomized to receive either multimodal analgesia (Study group) or conventional opioid-based analgesia (Control group). The multimodal analgesic protocol consists of pre-operative acetaminophen and gabapentin, intra-operative flurbiprofen and ropivacaine, and post-operative acetaminophen and celecoxib. Both groups received an on-demand mode patient-controlled analgesia pump containing morphine for rescue analgesia. The primary outcome was Quality of Recovery-40 score at postoperative day (POD) 2. Secondary outcomes included numeric pain scores (NRS), opioid consumption, clinical recovery, C-reactive protein, and adverse events.

Results

One hundred thirty-eight patients completed the study. The global QoR-40 scores at POD 2 were not significantly different between groups, although scores in the pain dimension were higher in Study group (32.1 ± 3.0 vs. 31.0 ± 3.2, P = 0.033). In the Study group, NRS pain scores, morphine consumption, and rescue analgesics in PACU (5.8% vs. 27.5%; P = 0.0006) were lower, time to ambulation [5.0 (3.3–7.0) h vs. 6.5 (5.0–14.8) h; P = 0.003] and time to bowel function recovery [14.5 (9.5–19.5) h vs.17 (13–23.5) h; P = 0.008] were shorter, C-reactive protein values at POD 2 was lower [4(3–6) ng/ml vs. 5 (3–10.5) ng/ml; P = 0.022] and patient satisfaction was higher (9.8 ± 0.5 vs. 8.8 ± 1.2, P = 0.000).

Conclusion

For minimally invasive laparoscopic gynecological surgery, multimodal analgesia based enhanced recovery protocol offered better pain relief, lower opioid use, earlier ambulation, faster bowel function recovery and higher patient satisfaction, while no improvement in QoR-40 score was found.

Trial registration

ChiCTR1900026194; Date registered: Sep 26,2019.

Quadratus lumborum block for patients undergoing percutaneous nephrolithotomy: A randomized controlled study

Background:

Recent studies have supported the use of quadratus lumborum block (QLB) for postoperative analgesia for patients undergoing renal surgery.

Aims:

The aim was to study the efficacy of posterior QLB for postoperative analgesia in patients undergoing percutaneous nephrolithotomy (PCNL).

Settings and Design:

This trial was a hospital-based, randomized, double-blind, controlled, prospective study.

Materials and Methods:

Forty patients aged from 18 to 60 years, belonging to the American Society of Anesthesiologists physical status I–III and scheduled for unilateral PCNL under spinal anesthesia were administered ultrasound-guided posterior QLB with 30 ml of either 0.2% ropivacaine (Group Q) or normal saline (Group C) after the subarachnoid block. Duration of analgesia was the primary outcome variable.

Statistical Analysis Used:

Data were compiled in Microsoft Excel, and analyses were performed in SPSS (version 24.0.0.0; IBM, Armonk, New York, USA). Unpaired t-test, Mann–Whitney U test, and Fisher's exact test were used for the comparison of continuous, ordinal, and categorical data, respectively.

Results:

Duration of analgesia was significantly longer in Group Q (1167.10 ± 89.74 vs. 290.25 ± 47.38 min), as compared to Group C. Except at the end of the surgery, visual analog scale at rest and on movement was significantly lower till 20^th h in Group Q. Patient satisfaction was better, and analgesic consumption was lower in Group Q. Side effects were similar in both groups.

Conclusions:

QLB provides good quality, and prolonged duration of postoperative analgesia compared to placebo for PCNL, but more large-scale studies are needed to recommend it for routine use.

To evaluate the effect of quadratus lumborum block on the tramadol sparing effect in patients undergoing open inguinal hernia surgery: A randomised controlled trial

Background and Aims

An ultrasound-guided quadratus lumborum (QL) block provides both somatic and visceral analgesia in abdominal surgeries. We aimed to evaluate the postoperative tramadol sparing effect of single-shot anterior QL block in inguinal hernia surgery patients.

Methods

This prospective, randomised controlled trial was conducted in a single tertiary care centre over a period of 1 year. A total of 50 patients, American Society of Anaesthesiologists (ASA) physical status I-II of both sexes aged 18-80 years with body mass index (BMI) ≥20 to ≤35 kg/m² undergoing uncomplicated unilateral inguinal hernia surgery under spinal anaesthesia (SA) were randomly allocated to either of the two groups. The block group (n = 25) received single-shot anterior QL block with 20 ml of 0.5% ropivacaine and the control group (n = 25) received no block. Postoperatively, patients received intravenous (IV) paracetamol 1g every 6 h and tramadol patient-controlled analgesia up to 24 h. Primary outcome was total tramadol consumption at 24 h postoperatively.

Results

The total tramadol consumption mean ± SD [95% CI (range)] at 24 h in the block group was 84.00 ± 37.86 [68.37-99.63 (20-160)] mg versus 93.60 ± 34.99 [79.16-108.04 (20-160)] mg in control group, (p value = 0.36). Postoperative VAS score, haemodynamics, and patient satisfaction score were similar in both the groups. No adverse events were reported.

Conclusion

A single-shot anterior QL block did not establish a postoperative tramadol-sparing effect at 24 h as compared to no block in patients undergoing inguinal hernia surgery under SA.

Interfascial Plane Blocks and Laparoscopic Abdominal Surgery: A Narrative Review

Laparoscopic abdominal surgery has become a mainstay of modern surgical practice. Postoperative analgesia is an integral component of recovery following laparoscopic abdominal surgery and may be improved by regional anesthesia or intravenous lidocaine infusion. There is inconsistent evidence supporting the use of interfascial plane blocks, such as transversus abdominis plane (TAP) blocks, for patients undergoing laparoscopic abdominal surgery as evidenced by variable patterns of local anesthetic spread and conflicting results from studies comparing TAP blocks to local anesthetic infiltration of laparoscopic port sites and multimodal analgesia. Quadratus lumborum (QL) and erector spinae plane (ESP) blocks may provide greater areas of somatic analgesia as well as visceral analgesia, which may translate to more significant clinical benefits. Aside from the locations of the surgical incisions, it is unclear what other factors should be considered when choosing one regional technique over another or deciding to infuse lidocaine intravenously. We reviewed the current literature in attempt to clarify the roles of various regional anesthesia techniques for patients undergoing laparoscopic abdominal surgery and present one possible approach to evaluating postoperative pain.

Future in regional anesthesia: new techniques and technological advancements

Regional anesthesia has a very interesting long history, initially preferred over general anesthesia because of safety concerns, then for a period general anesthesia became safer and was preferred. The use of innovative technologies such as ultrasound technology has made the blocks safer and successful by directly visualizing targeted nerves and the location of local anesthetics. With the wide use of ultrasound in the regional anesthesia field success rate of peripheral nerve blocks increased and novel blocks techniques developed. Moreover, new extended-release local anesthetic agents have begun to be promising time-efficient and longer duration of analgesia with a single injection. In this article, we attempt to summarize some of the novel block techniques, pharmacological agents, and new technologies in the field of regional anesthesia.

[Peripheral truncal blocks-Overview and assessment]

By implementation of sonography for regional anesthesia, truncal blocks became more relevant in the daily practice of anesthesia and pain therapy. Due to visualized needle guidance ultrasound supports more safety and helps to avoid complications during needle placement. Additionally, complex punctures are possible that were associated with higher risk using landmarks alone. Next to the blocking of specific nerve structures, interfascial and compartment blocks have also become established, whereby the visualization of individual nerves and plexus structures is not of relevance. The present review article describes published and clinically established puncture techniques with respect to the indications and procedures. The clinical value is reported according to the scientific evidence and the analgesic profile. Moreover, the authors explain potential risks, complications and dosing of local anesthetic agents.

The Effect of the Modified Thoracolumbar Interfacial Nerve Plane Block on Postoperative Analgesia and Healing Quality in Patients Undergoing Lumbar Disk Surgery: A Prospective, Randomized Study

Objective:

The purpose of this study was to investigate the effect of the modified thoracolumbar interfascial plane block (TLIP) on postoperative analgesia and quality of recovery in patients undergoing lumbar disk surgery.

Method:

Ninety patients scheduled for lumbar disk surgery were divided into a control group (Group C) and a modified TLIP block group (Group T). Controlled analgesia was administered to both groups. Pain evaluation was performed at 30 min and at 1., 2., 4., 8.,12., and 24. hrs using a VAS scale, with patients at rest and duringand patients completed the QoR-40 quality of recovery inventory.

Results:

Fentanyl used during postoperative 24 hours was 742.5±220.3 mcg in Group C and 446.0±241.98 in Group T. Postoperative fentanyl consumption was statistically significantly lower in Group T (p<0.001) with a statistically significant intergroup difference. The patient’s pain, physical independence, physical comfort, psychological support, and emotional support were compared using the QoR-40 questionnaire survey. Significant differences in favor of Group T were observed (p<0.001, p=0.017, p=0.002, p=0.001 and p<0.001, respectively). Static and dynamic pain scores in Group C and Group T were recorded at 30 min and at 1, 2, 4, 8, 12, and 24^h. Mean static scores were statistically significantly different in favor of Group T with the exception of 8^th and 12^h assessments (p<0.05). Dynamic scores were statistically significantly different in favor of Group T at all time points (p<0.05).

Conclusion:

Pain scores, opioid consumption and QoR-40 values after lumbar disk surgery were superior in the group undergoing TLIP. We think that the modified TLIP block may be an important method in terms of postoperative analgesia and patient recovery for lumbar spinal disk surgery.