Effect of Pre-incisional Ultrasound-guided Quadratus Lumborum Block on Perioperative Analgesia and Inflammatory Responses in Transperitoneal Laparoscopic Nephrectomy: A Single-blinded, Randomised Control Trial

A Quadratus lumborum (QL) block produces an effective lower abdominal surgery perioperative analgesia, which has been reported to improve perioperative pain intensity and inflammatory responses. This prospective randomised-control study evaluates the efficacy of a pre-incisional ultrasound-guided QL block in providing perioperative analgesia following a transperitoneal laparoscopic nephrectomy. Forty-four adult patients were randomly assigned into the control group or QL block group. Intraoperative fentanyl, post-operative Numerical Rating Scale (NRS) at rest and during movement and additional tramadol in the first 24 hours were recorded. Blood samples for interleukin-6 (IL-6) and hemodynamic profiles were recorded after anaesthesia induction, after two hours of surgery and two hours post-operation. The QL block group had lower intraoperative fentanyl (P < 0.05), lower post-operative NRS at rest and during movement (P < 0.001), lower IL-6 level (P < 0.05) and lower additional post-operative tramadol demand with a relative risk of 3.00 (1.43– 6.29, P < 0.05). The intraoperative hemodynamic profiles and after-surgery were significantly changed, compared to the baseline in the control group (P < 0.001), while the QL block group showed more stable profiles (P > 0.05). The pre-incisional QL block with 0.25% bupivacaine reduced the need for intraoperative opioid, showed more stable intraoperative hemodynamic changes and lowered inflammatory response, postoperative pain and the need for additional opioids following transperitoneal laparoscopic nephrectomy.