Analgesic Efficacy of Transverse Abdominis Plane Block and Quadratus Lumborum Block in Laparoscopic Sleeve Gastrectomy: A Randomized Double-Blinded Clinical Trial

Abstract

Introduction: The analgesic effect and safety of transversus abdominis plane block (TAPB) is still controversial in various abdominal procedures. Quadratus lumborum block (QLB) has been considered to provide a widespread and long-lasting analgesic effect in gynecological surgeries. However, the analgesic effects of these two techniques in patients with extreme obesity undergoing laparoscopic sleeve gastrectomy (LSG) are still unknown.

Methods: A total of 225 patients with obesity were randomly assigned to group TAPB (n = 76, 30 ml 0.33% ropivacaine with dexmedetomidine 1 μg kg^-1), group QLB (n = 76, 30 ml 0.33% ropivacaine with dexmedetomidine 1 μg kg^-1), or general anesthesia alone (GA, n = 73, 30 ml 0.9% saline). During the 48-h postoperative period, patients received continuous intravenous patient-controlled analgesia (PCA) containing sufentanil 2 μg kg^-1, dexmedetomidine 2 μg kg^-1, and granisetron 3 mg. The scores of visual analogue scale (VAS) in surgical incision and viscera, considering as the primary outcomes, were continuously recorded at postoperative 0, 0.5, 1, 2, 6, 12, 24, 48 h and discharge.

Results: Comparing with patients in the GA group, VAS scores of incision and viscera were consistently reduced during the initial 6-12 h after LSG in TAPB and QLB groups, and they received less propofol and remifentanil (P < 0.001) as well. In the QLB group, patients had longer duration for the first rescue analgesia, and fewer requirements of the rescue analgesia within 24 h than the GA group (P < 0.05). In addition, there were fewer PCA requirements in QLB group than GA and TAPB groups (P < 0.05).

Conclusions: Ultrasound-guided transversus abdominis plane block and quadratus lumborum block could provide comparable analgesic effects for a laparoscopic sleeve gastrectomy in obese patients.

Trial registration: Chinese Clinical Trial Registry; ChiCTR1800019236.

Keywords: Laparoscopic sleeve gastrectomy; Obesity; Postoperative pain; Quadratus lumbar nerve block; Transversus abdominis plane block.

Fig. 1

CONSORT flow diagram. GA general anesthesia, TAPB transversus abdominis plane block, QLB quadratus lumborum block

Fig. 2

Pain scores in viscera and incision over time in obese patients after laparoscopic sleeve gastrectomy. Data are given as mean ± SD; GA general anaesthesia, TAPB transversus abdominis plane block, QLB quadratus lumborum block, VAS visual analog scale from 0 to 10 cm. *P < 0.05, TAPB vs. GA at the same time point. ^#P < 0.05, QLB vs. GA at the same time point

Fig. 3

Number of postoperative hypotensive patients after laparoscopic sleeve gastrectomy. Data are given as percentage (%). GA general anesthesia, TAPB transversus abdominis plane block, QLB quadratus lumborum block. T0 (baseline, before anesthesia), T1 (anesthesia intubation), T2 (pneumoperitoneum complete), T3 (gastrectomy), T4 (extubation), T5 (PACU entering), T6 (PACU 1 h)