Analgesic efficacy of ultrasound-guided continuous quadratus lumborum block versus continuous paravertebral block in radical cystectomy: a randomized study

Abstract

Background Various techniques of regional anesthesia have been used in abdominal surgery including thoracic epidural, thoracic paravertebral block (TPVB), and transversus abdominis plane block. However, new techniques such as quadratus lumborum (QL) block are tested to detect its efficacy. Purpose To compare between intraoperative and postoperative analgesic effects of ultrasound-guided continuous QL block and continuous TPVB in patients operated for radical cystectomy (primary outcome). Side effects, length of hospital stay, and patient satisfaction are the secondary outcome. Patients and methods Sixty patients admitted to the Urosurgery Department at Alexandria Main University Hospital for radical cystectomy were randomly assigned into two groups, 30 patients for each group: group I received ultrasound-guided QL block with 0.3\u2009ml/kg bupivacaine 0.25% on each side with catheter insertion for maintenance doses of 0.1\u2009ml/kg/h on each side while group II received ultrasound-guided TPVB with 0.3\u2009ml/kg bupivacaine 0.25% on each side with catheter insertion for maintenance doses of 0.1\u2009ml/kg/h on each side. Results There was no statistically significant difference between the two groups regarding postoperative visual analog scale score, first request of analgesia, and length of hospital stay; however, there was statistically significant difference between the two groups as regards heart rate and mean blood pressure at the 1st, 4th, 6th, and 7th hours during the intraoperative periods. Conclusion It can be concluded that there is no difference in analgesic efficacy, opioid consumption, and hospital stay between continuous bilateral QL block and continuous bilateral TPVB after radical cystectomy. These data suggest that QL block is a viable alternative for delivering multimodal analgesia in radical cystectomy.