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Li Y, Wang L, Sun J, Xie T, Fu J, Feng C, Lu G. Effects of Subcostal Anterior Quadratus Lumborum Block with and without Dexmedetomidine on Postoperative Rehabilitation in Patients Undergoing Laparoscopic Renal Surgery: A Prospective Double-Blinded Randomized Controlled Study. Drug Des Devel Ther 2023; 17:3281-3293. [PMID: 38024533 PMCID: PMC10644893 DOI: 10.2147/dddt.s422356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background The combination of different anesthesia techniques or adjuvant drugs can relieve the stress response to surgery, reduce adverse reactions and improve the clinical outcome. We investigated the effects of subcostal anterior quadratus lumborum block (SQLB) with and without dexmedetomidine (DEX) on postoperative rehabilitation for laparoscopic renal surgery (LRS). Methods We included 90 patients in this single-center study. All were scheduled for elective laparoscopic radical or partial nephrectomy under general anesthesia (GA). We randomly and evenly assigned them to three groups: Group GA (GA alone), Group QG (SQLB with 30 mL of 0.25% ropivacaine and GA), and Group DQG (SQLB with 30 mL of 0.25% ropivacaine plus 1 μg/kg DEX and GA). The primary outcomes were serum creatinine (Cr) and blood urea nitrogen (BUN) levels; the secondary outcomes included the average numeric rating scale (NRS) scores at rest and during activity within 48 h postoperatively; perioperative opioid consumption; the time to first ambulation, exhaust, and fluid intake, and postoperative adverse reactions. Results The serum Cr and BUN levels in Group DQG decreased significantly compared with Group GA (P < 0.05). The average NRS scores in Group DQG were significantly lower than other two groups (P < 0.05). Furthermore, the indexes reduced significantly in Group QG compared with Group GA (P < 0.05). Groups DQG and QG had lower consumption of opioid compared with Group GA (P < 0.05). The recovery indicators in Groups DQG and QG were higher quality than Group GA (P < 0.05). The incidences of adverse reactions in Group DQG was significantly lower than the other groups (P < 0.05). Conclusion SQLB with and without DEX could attenuate postoperative pain, reduce opioids requirement and side effects, as well as facilitate postoperative early rehabilitation. More interesting, SQLB with DEX could confer kidney protection. Clinical Trial Registration Number The Chinese Clinical Trial Registry (ChiCTR2200061554).
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Affiliation(s)
- Youqin Li
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
- Department of Anesthesiology, First People's Hospital of Jinan, Jinan, 250011, People's Republic of China
| | - Lulu Wang
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Jing Sun
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Tian Xie
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Jia Fu
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Chang Feng
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
| | - Guodong Lu
- Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China
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Onay M, Erdoğan Kayhan G, Özen A, Şanal Baş S, Yelken B. Comparison of ultrasound-guided quadratus lumborum block and erector spinae plane block in terms of their effects on postoperative pain in open nephrectomy. Minerva Anestesiol 2023; 89:32-39. [PMID: 36287390 DOI: 10.23736/s0375-9393.22.16635-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Ultrasound-guided quadratus lumborum block (QLB 2) and erector spinae plane block (ESPB) were suggested to prevent somatic and visceral pain in a small number of abdominal surgeries. In this study, we aimed to compare these fascial plane blocks in terms of efficacy and safety in patients undergoing open nephrectomy. METHODS This double-blind randomized controlled trial included a total of 40 patients (aged 18-70 years, with an ASA Score of I-III) and underwent partial or radical nephrectomy with subcostal incision. Unilateral ESPB and QLB 2 were performed at the end of the operation. The patients were then assessed for total morphine consumption, pain scores, and side effects at the postoperative 24th hour. RESULTS The ESPB and QLB 2 groups showed similar total morphine consumption (20.95+12.40 mg and 25.05+13.60 mg, P=0.870) and morphine demands (37.85+29.43 and 41.15+31.75, P=1.000), respectively. Despite the lower VAS scores at rest and movement in the ESPB group, there were no statistically significant differences between groups. CONCLUSIONS Ultrasound-guided QLB 2 and ESP block were found to achieve similar results on at rest and at movement pain scores and morphine consumption of the patients undergoing open nephrectomy. Both blocks may be preferred, depending on the clinician's experience.
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Affiliation(s)
- Meryem Onay
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey -
| | - Gülay Erdoğan Kayhan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Ata Özen
- Department of Urology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Sema Şanal Baş
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Birgül Yelken
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
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Muacevic A, Adler JR, Prakash R, Khan MP. Ultrasound-Guided Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Laparoscopic Inguinal Hernia Repair and Appendicectomy Using Ropivacaine With Dexmedetomidine. Cureus 2023; 15:e33450. [PMID: 36751249 PMCID: PMC9897688 DOI: 10.7759/cureus.33450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
Background The present study aims to investigate the efficacy of ultrasound-guided quadratus lumborum (QL) block versus transversus abdominis plane (TAP) block for laparoscopic inguinal hernia repair and appendicectomy using ropivacaine with dexmedetomidine for quality and duration of postoperative analgesia. Settings and design This was a prospective, randomized, single-blind study conducted for one year (September 2020-August 2021) in the Department of Anesthesiology and Critical Care, King George's Medical University, Lucknow, after obtaining ethical clearance from the institutional ethics committee. Methods A total of 64 patients of American Society of Anesthesiologists (ASA) grades I-II and ages between 20 and 50 years undergoing laparoscopic inguinal hernia repair and appendicectomy were randomly allocated into two groups of 32 each; group A received ultrasonography (USG)-guided quadratus lumborum block using 0.5% ropivacaine 20 ml with dexmedetomidine 0.5 mcg/kg of body weight, and group B was given USG-guided transversus abdominis plane block using 0.5% ropivacaine 20 ml with dexmedetomidine 0.5 mcg/kg of body weight after the induction of general anesthesia and before surgical incision. Data were analyzed using Student's t-test, Mann-Whitney U test, and chi-square test as applicable. Results The duration of analgesia was statistically higher (P<0.001) in group A (21.00±3.73 hours) as compared to group B (14.44±2.99 hours). Group A had significantly less analgesic (P<0.001) at 12, 18, and 24 hours postoperatively. The visual analog scale (VAS) was significantly decreased in group A at rest and movement. The range of percentage changes in heart rate (HR) was significantly higher in group B as compared to group A at 12, 18, and 24 hours (group A: 7.23%-14.70%; group B: 6.41%-28.01%). The mean blood pressure (MBP) was significantly increased in group B at 12, 18, and 24 hours as compared to group A. The range of changes in baseline MBP in group A was less than in group B (group A: 0.73%-8.34%; group B: 0.73%-18.20%). Conclusion Quadratus lumborum block is effective and better than transversus abdominis plane block for providing postoperative analgesia during laparoscopic inguinal hernia repair and appendicectomy.
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Cai Q, Liu G, Liu Z, Gao M, Huang L, He F, Liu S, Lin Y, Wei H, Dou Z, Liu D, Hu Y, Gong X. Efficacy of quadratus lumborum block on postoperative pain and side effects in patients who underwent urological surgery: A meta-analysis. Pain Pract 2023; 23:70-82. [PMID: 35726437 DOI: 10.1111/papr.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/13/2022] [Accepted: 05/31/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Ultrasound-guided quadratus lumborum block (QLB) is considered a novel nerve block for postoperative pain control. However, its efficacy after urological surgery remains unclear. OBJECTIVES The purpose of the current meta-analysis was to evaluate the effects of the QLB block versus control (placebo or no injection) on postoperative pain and other adverse outcomes after urological surgery, providing extensive evidence of whether quadratus lumborum block is suitable for pain management after urological surgery. STUDY DESIGN Systematic review with meta-analysis of randomized clinical trials. METHODS We searched PubMed, Cochrane Library, Embase, Web of Science, and ClinicalTrials.gov to collect studies investigating the effects of QLB on analgesia after urological surgery. The primary outcomes included visual analog scale (VAS) at rest and during movement, 24-h postoperative morphine consumption, and the incidence of postoperative nausea and vomiting (PONV). RESULTS Overall, 13 randomized controlled trials (RCTs) were reviewed, including 751 patients who underwent urological surgery. The QLB group exhibited a lower VAS score postoperatively at rest or on movement at 0, 6, 12, and 24 h, with less 24-h postoperative morphine consumption and lower incidence of PONV. LIMITATIONS Although the result is stable, heterogeneity exists in the current research. CONCLUSIONS QLB exhibited a favorable effect of postoperative analgesia with reduced postoperative complications at rest or during movement after urological surgery. However, it is still a novel technology at a primary stage, which needs further research to develop.
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Affiliation(s)
- Qiang Cai
- Department of Orthopedics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China.,Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | | | | | - Meiling Gao
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Linsheng Huang
- Department of Hepatobiliary Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Fuhai He
- Guangxi Medical University, Nanning, China
| | | | - Yunhua Lin
- Guangxi Medical University, Nanning, China
| | - Huixia Wei
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Zhiqian Dou
- Department of Obstetrics, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Dexi Liu
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yang Hu
- Department of Orthopedics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Xingrui Gong
- Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
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Analgesic Effect of Ultrasound-Guided Anterior Quadratus Lumborum Block at the L2 Level in Patients Undergoing Laparoscopic Partial Nephrectomy: A Single-Center, Randomized Controlled Trial. Pain Res Manag 2022; 2022:8958859. [PMID: 36569463 PMCID: PMC9779996 DOI: 10.1155/2022/8958859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
Objectives This study aimed to evaluate the effect of ultrasound-guided anterior quadratus lumborum block (QLB) at the L2 level in patients undergoing laparoscopic partial nephrectomy. Methods Patients who were 18-70 years old with an American Society of Anesthesiologists (ASA) physical status of 1-2 and were scheduled for elective laparoscopic partial nephrectomy were recruited into the cluster randomized controlled trial. Sixty-three patients were randomly allocated to receive QLB (group Q, n = 32) or no block (group C, n = 31). The patients were not masked to the group allocations. The postoperative follower was blinded to the group allocations. All patients received total intravenous anesthesia, the same multimodal analgesic regimen, and rescue analgesia when needed. The primary outcome was perioperative cumulative sufentanil consumption. Results 30 patients in group Q and 29 patients in group C were included in the statistical analysis. Block-related complications were not found in this study. Sufentanil consumption during the perioperative period (155.41 [19.58] vs 119.37 [12.41] μg, p < 0.001) and sufentanil dosage during surgery and 0-6 h, 6-12 h, and 12-24 h after surgery were lower in group Q than in group C, while 24-48 h after surgery was similar between both groups. The median sensory blockade area in group Q was T9-L1. Comparison of invasive blood pressure (BP) and heart rate (HR) before and after skin incision in group C was statistically significant, but there was no significant difference in group Q. Both at rest and during activity, numerical rating scale (NRS) scores and the incidence of rescue analgesia were lower in group Q at any time point after surgery. The incidences of postoperative nausea and vomiting (PONV), time from postoperative to discharge, postoperative recovery quality, or anesthesia satisfaction were similar between the two groups. Conclusions Anterior QLB at the L2 level can reduce the perioperative dosage of sufentanil and the degree of postoperative pain in patients undergoing laparoscopic partial nephrectomy, but it did not improve postoperative recovery quality and anesthesia satisfaction.
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Dalili D, Ahlawat S, Isaac A, Rashidi A, Fritz J. Selective MR neurography-guided anterior femoral cutaneous nerve blocks for diagnosing anterior thigh neuralgia: anatomy, technique, diagnostic performance, and patient-reported experiences. Skeletal Radiol 2022; 51:1649-1658. [PMID: 35150298 DOI: 10.1007/s00256-022-04014-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the clinical utility of selective magnetic resonance neurography-(MRN)-guided anterior femoral cutaneous nerve (AFCN) blocks for diagnosing anterior thigh neuralgia. MATERIALS AND METHODS Following institutional review board approval and informed consent, participants with intractable anterior thigh pain and clinically suspected AFCN neuralgia were included. AFCN blocks were performed under MRN guidance using an anterior groin approach along the medial sartorius muscle margin. Outcome variables included AFCN identification on MRN, technical success of perineural drug delivery, rate of AFCN anesthesia, complications, total procedure time, patient-reported procedural experiences, rate of positive diagnostic AFCN blocks, and positive subsequent treatment rate. RESULTS Eighteen MRN-guided AFCN blocks (six unilateral and six bilateral blocks) were performed in 12 participants (6 women; age, 49 (30-65) years). Successful MRN identified the AFCN, successful perineural drug delivery, and AFCN anesthesia was achieved in all thighs. No complications occurred. The total procedure time was 19 (10-28) min. Patient satisfaction and experience were high without adverse MRI effects. AFCN blocks identified the AFCN as the symptom generator in 16/18 (89%) cases, followed by 14/16 (88%) successful treatments. CONCLUSION Our results suggest that selective MR neurography-guided AFCN blocks effectively diagnose anterior femoral cutaneous neuralgia and are well-tolerated.
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Affiliation(s)
- Danoob Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, London, Epsom, KT18 7EG, UK.,Department of Diagnostic and Interventional Radiology, Epsom and St Helier University Hospitals NHS Trust, Dorking Road, London, Epsom, KT18 7EG, UK.,The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Amanda Isaac
- Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Ali Rashidi
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, USA.
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7
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Liu D, Zhang G, Zhu Y, Liu X, Xu S, He M, Chen S, An K, Liang G, Zhu Z. Effectiveness of Ultrasound-Guided Retrolaminar Block and Erector Spinae Plane Block in Retroperitoneal Laparoscopic Surgery: A Randomized Controlled Trial. J Pain Res 2022; 15:815-826. [PMID: 35370419 PMCID: PMC8974250 DOI: 10.2147/jpr.s349028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/24/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose Retrolaminar block (RLB) and erector spine plane block (ESPB) share a similar block site, but their analgesia principle may differ. This study compared the postoperative analgesic effects of ultrasound-guided RLB and ESPB for retroperitoneal laparoscopic surgery. Patients and Methods The study included patients who scheduled for laparoscopic nephrectomy from July 2020 to January 2021. Patients in RLB group received a three-point block at the posterior surface of T8-T10 lamina, and those in ESPB group received at the T9 level. The primary result was the score of visual analogue scale (VAS). Secondary results included information on intraoperative and postoperative analgesia consumption and rescue analgesia usage, skin temperature, serum interleukin (IL)-1β, prostaglandin E2 (PGE2) level and the occurrence of safety events. Results There was no significant difference between the two groups in the postoperative VAS scores at both the rest and cough state (All P>0.05). The skin surface temperature of the affected side and the healthy side in ESPB group was higher than that in the RLB group at the end of the surgery (P=0.002) and after surgery (P=0.016). The RLB group had a higher ephedrine usage than the ESPB group (P=0.027). Compared with the ESPB group, the RLB group had a shorter time to exhaust (P=0.045) and lower serum IL-1β level (P=0.049). Patients in neither group developed severe adverse event. Conclusion Ultrasound-guided RLB and ESPB can provide safe and effective postoperative analgesia for retroperitoneal laparoscopic surgery. ESPB has more stable intraoperative hemodynamics, while RLB has more potential research value for patients’ rapid recovery.
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Affiliation(s)
- Dexing Liu
- Medical College of Soochow University, Soochow University, Suzhou, People’s Republic of China
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, People’s Republic of China
| | - Guangting Zhang
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, People’s Republic of China
| | - Yuhang Zhu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, People’s Republic of China
| | - Xingxing Liu
- Medical College of Soochow University, Soochow University, Suzhou, People’s Republic of China
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, People’s Republic of China
| | - Shan Xu
- Medical College of Soochow University, Soochow University, Suzhou, People’s Republic of China
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, People’s Republic of China
| | - Miao He
- Medical College of Soochow University, Soochow University, Suzhou, People’s Republic of China
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, People’s Republic of China
| | - Shulian Chen
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, People’s Republic of China
| | - Ke An
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, People’s Republic of China
| | - Guobiao Liang
- Medical College of Soochow University, Soochow University, Suzhou, People’s Republic of China
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, People’s Republic of China
| | - Zhaoqiong Zhu
- Medical College of Soochow University, Soochow University, Suzhou, People’s Republic of China
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, People’s Republic of China
- Correspondence: Zhaoqiong Zhu, Tel +86-851-28609145, Fax +86-851-28609145, Email
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Evaluation of Analgesia Effect after Ultrasound-Guided Laparoscopic Renal Surgery. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2021:6194806. [PMID: 34976111 PMCID: PMC8719997 DOI: 10.1155/2021/6194806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 11/27/2021] [Accepted: 12/13/2021] [Indexed: 12/31/2022]
Abstract
Kidney surgery involves placing the kidney in the iliac fossa of the lower abdomen on the right or left side. Studies have found that most kidney patients experience moderate to severe pain after surgery. The stress response caused by postoperative pain, especially visceral pain, not only aggravates the patient's pain and irritability and aggravates the original complications but may also harm the early recovery of renal function and affect the survival of the kidney. Therefore, adequate postoperative analgesia for renal patients is essential. This paper combines ultrasound-guided laparoscopic technology to improve the postoperative analgesia effect of renal surgery and compares the data with experimental research methods. Through experimental research, it can be seen that the method proposed in this article has a certain effect, and ultrasound-guided laparoscopic technology can be used in follow-up clinical research to improve the analgesic effect of renal surgery.
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Emmerson J, Todd S, Brown JM. Recommendations for designing and analysing multi-arm non-inferiority trials: a review of methodology and current practice. Trials 2021; 22:417. [PMID: 34174937 PMCID: PMC8235859 DOI: 10.1186/s13063-021-05364-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/09/2021] [Indexed: 09/02/2023] Open
Abstract
Background and purpose Multi-arm non-inferiority (MANI) trials, here defined as non-inferiority trials with multiple experimental treatment arms, can be useful in situations where several viable treatments exist for a disease area or for testing different dose schedules. To maintain the statistical integrity of such trials, issues regarding both design and analysis must be considered, from both the multi-arm and the non-inferiority perspectives. Little guidance currently exists on exactly how these aspects should be addressed and it is the aim of this paper to provide recommendations to aid the design of future MANI trials. Methods A comprehensive literature review covering four databases was conducted to identify publications associated with MANI trials. Literature was split into methodological and trial publications in order to investigate the required design and analysis considerations for MANI trials and whether they were being addressed in practice. Results A number of issues were identified that if not properly addressed, could lead to issues with the FWER, power or bias. These ranged from the structuring of trial hypotheses at the design stage to the consideration of potential heterogeneous treatment variances at the analysis stage. One key issue of interest was adjustment for multiple testing at the analysis stage. There was little consensus concerning whether more powerful p value adjustment methods were preferred to approximate adjusted CIs when presenting and interpreting the results of MANI trials. We found 65 examples of previous MANI trials, of which 31 adjusted for multiple testing out of the 39 that were adjudged to require it. Trials generally preferred to utilise simple, well-known methods for study design and analysis and while some awareness was shown concerning FWER inflation and choice of power, many trials seemed not to consider the issues and did not provide sufficient definition of their chosen design and analysis approaches. Conclusions While MANI trials to date have shown some awareness of the issues raised within this paper, very few have satisfied the criteria of the outlined recommendations. Going forward, trials should consider the recommendations in this paper and ensure they clearly define and reason their choices of trial design and analysis techniques.
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Affiliation(s)
- Jake Emmerson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK.
| | - Susan Todd
- Department of Mathematics and Statistics, University of Reading, Reading, RG6 6AX, UK
| | - Julia M Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
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Ultrasound-Guided Quadratus Lumborum Block for Postoperative Pain in Abdominoplasty: A Randomized Controlled Study. Plast Reconstr Surg 2021; 147:851-859. [PMID: 33710163 DOI: 10.1097/prs.0000000000007767] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Postoperative pain after abdominoplasty can delay postoperative ambulation, leading to life-threatening complications. Previous reports have shown the utility of quadratus lumborum block in providing adequate pain relief and avoiding side effects after numerous abdominal operations. The purpose of this randomized controlled trial was to demonstrate the efficacy of the quadratus lumborum block in abdominoplasty. METHODS Patients were randomly allocated to receive a bilateral quadratus lumborum block with either ropivacaine or normal saline. Postoperative cumulative analgesic medication consumption, pain severity at rest and on movement, and quality of recovery were evaluated and compared in both groups. RESULTS Twenty patients were allocated to each group. Total morphine dose received in the postanesthesia care unit was lower in the ropivacaine group than in the control group, with a mean of 3.4 mg and 6.6 mg, respectively. Cumulative tramadol consumption per patient in the first 48 hours postoperatively was significantly lower in the ropivacaine group compared with the control group (42.5 mg versus 190 mg; p = 0.0031). The Numeric Rating Scale both at rest and with effort was significantly lower in the ropivacaine group compared with the control group. The median quality of recovery for the ropivacaine group was 133 compared with 112 for the control group (p < 0.0001). CONCLUSIONS Quadratus lumborum block in abdominoplasty reduces postoperative pain and opioid consumption and improves the quality of recovery. Further studies are needed to compare the quadratus lumborum block to more traditional blocks. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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11
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Liu D, Xu X, Zhu Y, Liu X, Zhao F, Liang G, Zhu Z. Safety and Efficacy of Ultrasound-Guided Retrolaminar Block of Multiple Injections in Retroperitoneal Laparoscopic Nephrectomy: A Prospective Randomized Controlled Study. J Pain Res 2021; 14:333-342. [PMID: 33574697 PMCID: PMC7872929 DOI: 10.2147/jpr.s282500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/12/2021] [Indexed: 01/16/2023] Open
Abstract
Purpose Ultrasound-guided retrolaminar block (RLB) has the potential to provide postoperative analgesia in retroperitoneal laparoscopic surgery. This study was conducted to evaluate the effects of RLB when compared with local infiltration analgesia (LIA) in retroperitoneal laparoscopic nephrectomy. Patients and Methods One hundred and fifteen patients scheduled for laparoscopic nephrectomy were divided into two groups: the RLB group (n = 57) received an ultrasound-guided RLB, while the LIA group (n = 58) received LIA. At 2, 4, 6, 24, and 48 hours after operation, the maximal visual analog score (VAS), sufentanil and rescue analgesia consumption, and the utilization of patient-controlled intravenous analgesia (PCIA) were assessed. The incidence rates of postoperative nausea and vomiting (PONV); time of leaving bed (at the first instance); and the levels of plasma β-Endorphin (β-EP), Interleukin-1β (IL-1β), and prostaglandin E2 (PEG2) 30 min after extubation were noted. Results Patients in the RLB group had significantly lower VAS scores; lower sufentanil cumulative consumption; lower manual addition frequency of PCIA; lower proportion of using rescue analgesia within 48 hours after operation; lower incidence rate of PONV; shorter resuscitation times; earlier time of leaving the bed; and lower β-EP, IL-1 β, and PEG2 levels. Conclusion Ultrasound-guided RLB of multiple injections is both safe and controllable for postoperative analgesia after retroperitoneal laparoscopic nephrectomy. When compared with LIA, RLB has better and longer-lasting analgesic effect, lower incidence rates of PONV, and the potential to reduce the level of postoperative inflammatory factors. Trial Registration China Clinical Trials Registration Center (http://www.chictr.org.cn, No. ChiCTR1800017526, Date of registration: 2018-08-02).
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Affiliation(s)
- Dexing Liu
- Soochow University Medical College, Suzhou, 215000, People's Republic of China.,Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, People's Republic of China
| | - Xinpeng Xu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, People's Republic of China
| | - Yuhang Zhu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, People's Republic of China
| | - Xingxing Liu
- Soochow University Medical College, Suzhou, 215000, People's Republic of China.,Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, People's Republic of China
| | - Faliang Zhao
- Soochow University Medical College, Suzhou, 215000, People's Republic of China.,Department of Urology, Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, People's Republic of China
| | - Guobiao Liang
- Soochow University Medical College, Suzhou, 215000, People's Republic of China.,Department of Urology, Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, People's Republic of China
| | - Zhaoqiong Zhu
- Soochow University Medical College, Suzhou, 215000, People's Republic of China.,Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, People's Republic of China
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Wang Y, Wang X, Zhang K. Effects of transversus abdominis plane block versus quadratus lumborum block on postoperative analgesia: a meta-analysis of randomized controlled trials. BMC Anesthesiol 2020; 20:103. [PMID: 32366275 PMCID: PMC7199334 DOI: 10.1186/s12871-020-01000-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 04/01/2020] [Indexed: 02/08/2023] Open
Abstract
Background Trunk block technique has been used in postoperative analgesia for patients undergoing surgery, specifically, transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) have been proved effective. The purpose of this meta-analysis is to evaluate the effects of TAPB and QLB in postoperative analgesia. Methods Online databases, including MEDLINE, EMBASE, Cochrane Library (&Trail), Web of Science, CNKI, Wanfang and QVIP were applied to collect the randomized controlled trials (RCTs) from inception to Dec. 9th, 2019. Twenty-two studies were finally included containing 777 patients in the TAPB group and 783 cases in QLB group. RCTs comparing TAPB and QLB in postoperative analgesia were included in this meta-analysis. The indicators including total analgesia consumption postoperatively, operative time, duration of anesthesia, visual analogue scale (VAS) score at 24 h postoperatively, duration of postoperative analgesia, the number of patients requiring analgesia postoperatively and adverse reactions were analyzed. Results our findings showed that morphine consumption (mg) (WMD = 3.893, 95%CI: 2.053 to 5.733, P < 0.001), fentanyl consumption (μg) (WMD = 23.815, 95%CI: 15.521 to 32.109, P < 0.001), VAS score at 24 h postoperatively (WMD = 0.459, 95%CI: 0.118 to 0.801, P = 0.008), the number of patients requiring analgesia postoperatively (WMD = 3.893, 95%CI: 2.053 to 5.733, P < 0.001), and the incidence of dizziness (WMD = 2.691, 95%CI: 1.653 to 4.382, P < 0.001) in TAPB group were higher than in QLB group. Conclusions QLB is superior to TAPB in reducing morphine consumption, fentanyl consumption, VAS score at 24 h postoperatively, the number of patients requiring analgesia postoperatively, and the incidence of dizziness.
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Affiliation(s)
- Yanqing Wang
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No.55, Section 4, South Renmin Road, Chengdu, 610041, People's Republic of China
| | - Xiaojia Wang
- Department of Pain management, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Kexian Zhang
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No.55, Section 4, South Renmin Road, Chengdu, 610041, People's Republic of China.
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