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Observational Study
. 2024 Sep 10;24(1):322.
doi: 10.1186/s12871-024-02691-7.

Effects of anterior quadratus lumborum block versus erector spinae plane block on postoperative acute pain in percutaneous nephrolithotomy: a prospective, observational study

Huseyin Turkan #  1 , Cengiz Kaya #  1 , Esra Turunc  2 , Burhan Dost  1 , Yasemin Burcu Ustun  1
Affiliations
Observational Study

Effects of anterior quadratus lumborum block versus erector spinae plane block on postoperative acute pain in percutaneous nephrolithotomy: a prospective, observational study

Huseyin Turkan et al. BMC Anesthesiol. .

Abstract

Background: The study aimed to compare the pain-relieving effectiveness of anterior quadratus lumborum block (QLB3) and erector spinae plane block (ESPB), both of which have been documented to provide relief during abdominal surgery.

Methods: This prospective observational study, conducted between February and July 2023, included 96 patients who had undergone percutaneous nephrolithotomy (PCNL). Patients were divided into three groups: QLB3, ESPB, and control (no block) and received the corresponding nerve block in the preanesthetic room for regional block. Cumulative morphine consumption during the initial 24 h after PCNL, numerical rating scale resting/movement scores, intraoperative remifentanil usage, rescue analgesic requirements, time when the first analgesic was requested, and postoperative nausea and vomiting scores were documented and compared between the groups.

Results: Total median morphine consumption in the first 24 h postoperatively was similar in the QLB3 and ESPB groups but higher in the control group (QLB3, 7 mg [(Q1-Q3) 7-8.5]; ESPB, 8 mg [6.5-9]; control, 12.5 [10-17]; P < 0.001). Similarly, median intraoperative remifentanil consumption did not differ between the block groups but was higher in the control group (QLB3, 1082 µg [IQR 805.5-1292.7]; ESPB, 1278 µg [940.2-1297.5]; control, 1561 µg [1315-2068]; P < 0.001). The number of patients receiving rescue analgesic medication was similar in the block groups but higher in the control group (QLB3, n = 9 [30%]; ESPB, n = 14 [46.7%]; control, n = 21 [70%]; P = 0.008).

Conclusions: QLB3 and ESPB were adequate and comparable in providing postoperative analgesia as part of multimodal analgesia after PCNL.

Trial registration: The study was registered on ClinicalTrials.gov (Identifier: NCT05822492).

Keywords: Acute postoperative pain; Erector Spinae plane block; Nerve block; Percutaneous nephrolithotomy; Quadratus lumborum block; Ultrasonography.

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Conflict of interest statement

The authors declare no competing interests.

None.

Figures

Fig. 1
Fig. 1
A-B. The sonoanatomy for the QLB3 and ESPB. (A) US-guided QLB3. The relevant technique is depicted in an ultrasound image. The white line indicates needle trajectory, and the blue highlighted area is the desired spread of local anesthetic. (B) US-guided ESPB. The relevant technique is depicted in an ultrasound image. The white line indicates needle trajectory, the blue highlighted area is the desired spread of local anesthetic, and the dashed line denotes the pleura. QLB3, anterior quadratus lumborum block; QL, quadratus lumborum muscle; PMM, psoas major muscle; VC, vertebral corpus. ESPB, erector spinae plane block; ESM, erector spinae muscles; TP, transverse process; LA, local anesthetic
Fig. 2
Fig. 2
Consort flow diagram of the study. QLB3, anterior quadratus lumborum block; ESPB, erector spinae plane block
Fig. 3
Fig. 3
Postoperative NRS pain scores at rest and activity in the groups at different time points. Data are presented as median (Q1-Q3). QLB3, anterior quadratus lumborum block; ESPB, erector spinae plane block; PACU, post-anesthesia care unit; NRS, numerical rating scale
See this image and copyright information in PMC

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