Modified versus traditional subcostal anterior quadratus lumborum block for postoperative analgesia after laparoscopic nephrectomy: a randomized-controlled study.

Abstract

Purpose: To examine the ramifications of both the modified and traditional subcostal anterior quadratus lumborum block (SQLB) on postoperative analgesia in individuals undergoing laparoscopic nephrectomy.

Methods: Forty-six individuals slated for elective laparoscopic nephrectomy under general anesthesia were randomly assigned to acquire either traditional or modified SQLB using 20 mL of 0.5% ropivacaine. The primary outcome was intravenous morphine-equivalent intake during the first 24 h following surgery. Secondary outcomes included sensory block dermatomes, numerical rating scale (NRS) scores, the total number of patient-controlled analgesia (PCA) demands, rescue analgesic use, and complications related to opioids and nerve block.

Results: The modified SQLB group had significantly lower morphine-equivalent consumption compared to the traditional SQLB group within the initial 24 h after surgery (23.1 ± 4.3 vs. 34.7 ± 6.8 mg, P < 0.001). The modified SQLB also resulted in a greater number of dermatome segments of sensory block at 5, 10, and 15 min after block (P < 0.05), lower NRS pain scores at rest and during coughing at 6, 24, and 48 h (P < 0.001), and reduced usage of rescue analgesics as well as total PCA demands (P < 0.05). No significant differences were observed in the incidence of complications related to opioids or the nerve block procedure between the two groups.

Conclusions: Ultrasound-guided modified SQLB confers significantly superior analgesic advantages over the traditional SQLB for patients undergoing laparoscopic nephrectomy, culminating in a marked reduction in postoperative opioid consumption and more efficacious pain management.