Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
School of Medicine Greenville, University of South Carolina, Greenville, South Carolina, USA.
Clin Transplant. 2024 Aug;38(8):e15430. doi: 10.1111/ctr.15430.
Regional anesthesia is an alternative to opioids for pain in patients undergoing liver transplantation. Quadratus lumborum blocks may provide appropriate dermatomal coverage with an excellent safety profile.
Data were collected retrospectively on adult patients who underwent liver transplant at an academic medical center from 2019 to 2022 (n = 207). The primary outcome was opioid administration during the 48 h after transplant.
Patient demographics did not differ between groups. No association was found between patients who received a block and postoperative opioid administration (p = 0.848). However, among patients extubated in the operating room, patients who received a block reported, on average, a 0.9-unit lower pain score than patients who received no block (p = 0.041). Patients who received a block were also more likely to be extubated in the operating room (87.8% block vs. 44.4% no block; p < 0.001).
Patients who underwent liver transplantation had similar postoperative opioid use whether or not they received a quadratus lumborum block. Yet, when evaluating additional factors, such as extubation, pain scores were lower in patients who received a quadratus lumborum block. This important finding supports the idea that quadratus lumborum blocks may be a safe and valuable technique for controlling postoperative pain in adult patients who undergo liver transplantation.
区域麻醉是肝移植患者疼痛治疗的阿片类药物替代方案。腰方肌阻滞可提供适当的皮区覆盖,具有出色的安全性。
回顾性收集了 2019 年至 2022 年在学术医疗中心接受肝移植的成年患者的数据(n=207)。主要结局是移植后 48 小时内阿片类药物的使用。
患者的人口统计学特征在两组间无差异。接受阻滞与术后阿片类药物使用之间无关联(p=0.848)。然而,在手术室拔管的患者中,接受阻滞的患者报告的疼痛评分平均比未接受阻滞的患者低 0.9 个单位(p=0.041)。接受阻滞的患者也更有可能在手术室拔管(87.8%的阻滞组与 44.4%的无阻滞组;p<0.001)。
接受肝移植的患者无论是否接受腰方肌阻滞,术后阿片类药物的使用情况相似。然而,在评估其他因素(如拔管)时,接受腰方肌阻滞的患者的疼痛评分较低。这一重要发现支持了这样一种观点,即腰方肌阻滞可能是一种安全且有价值的技术,可用于控制接受肝移植的成年患者的术后疼痛。