Pai B H Poonam, Onayemi Abimbola, Lai Yan H
Anesthesiology, Mount Sinai Hospital, New York, USA.
Cureus. 2023 Mar 16;15(3):e36244. doi: 10.7759/cureus.36244. eCollection 2023 Mar.
Abdominal blocks such as quadratus lumborum block (QLB) have been used as an effective analgesic in abdominal surgeries. However, their efficacy in kidney surgery remains unknown. To the best of our knowledge, there are no clinical studies exploring the relationship between QLBs and post-operative opioid consumption in robotic laparoscopic nephrectomy.
To assess the analgesic efficacy of QLB and its impact on perioperative opioid consumption in robotic laparoscopic nephrectomy.
A retrospective chart review was conducted by querying the electronic medical record system of a 2,200-bed tertiary academic hospital center in New York City. The primary measured outcome was postoperative morphine milligram equivalents (MME) consumption for the first 24 hours. Secondary outcomes include intra-operative MME as well as postoperative pain scores measured on a visual analogue scale (VAS) scale at 2, 6, 12, 18, and 24 hours postoperatively.
The mean total postoperative MME in the posterior QLB (pQLB) group was 11 in the QLB group (interquartile range (IQR) 4, 18) and 15 in the control group (IQR 5.6, 28) . There was a significant reduction in intraoperative MME in the QLB group in comparison to the control group. This reduction was not seen in postoperative MME. There was no significant difference in pain scores at any of the measured time points up to 24 hours postoperatively.
Our study provides compelling support that ultrasound guided QLB significantly decreased intraoperative opioid requirements but did not have the same effect on postoperative opioid requirements following robotic kidney surgeries in the context of an enhanced recovery after surgery (ERAS) pathway.
诸如腰方肌阻滞（QLB）等腹部阻滞已被用作腹部手术中的一种有效镇痛方法。然而，其在肾脏手术中的疗效尚不清楚。据我们所知，尚无临床研究探讨QLB与机器人腹腔镜肾切除术术后阿片类药物消耗量之间的关系。
评估QLB在机器人腹腔镜肾切除术中的镇痛效果及其对围手术期阿片类药物消耗量的影响。
通过查询纽约市一家拥有2200张床位的三级学术医院中心的电子病历系统进行回顾性图表审查。主要测量结果是术后24小时内吗啡毫克当量（MME）的消耗量。次要结果包括术中MME以及术后2、6、12、18和24小时使用视觉模拟量表（VAS）测量的术后疼痛评分。
QLB组中后入路QLB（pQLB）组术后MME的平均总量为11（四分位间距（IQR）4，18），对照组为15（IQR 5.6，28）。与对照组相比，QLB组术中MME显著降低。术后MME未见这种降低。术后24小时内任何测量时间点的疼痛评分均无显著差异。
我们的研究有力支持了在术后加速康复（ERAS）路径的背景下，超声引导下的QLB显著降低了机器人肾脏手术后术中阿片类药物的需求量，但对术后阿片类药物需求量没有同样的效果。
