Posterior quadratus lumborum versus transversus abdominis plane block for inguinal hernia repair: a prospective randomized controlled study

Okur, Onur; Karaduman, Duygu; Tekgul, Zeki Tuncel; Koroglu, Noyan; Yildirim, Mehmet

doi:10.1016/j.bjane.2020.11.004

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Brazilian Journal of Anesthesiology

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Sumário

Clinical Research • para Braz. J. Anesthesiol. 71 (5) • Sep-Oct 2021 • https://doi.org/10.1016/j.bjane.2020.11.004 copy

Posterior quadratus lumborum versus transversus abdominis plane block for inguinal hernia repair: a prospective randomized controlled study^☆ ☆ This study was conducted in main theaters of the Izmir Bozyaka Training and Research Hospital.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background and objectives

We aimed to compare the analgesic effects of both posterior (type 2) Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane Block (TAPB) compared to spinal anesthesia alone for postoperative pain management in inguinal hernia repair.

Methods

This study enrolled 63 patients scheduled for open inguinal hernia repair. The eligibility criteria were undergoing elective unilateral inguinal hernia repair surgery, having an American Society of Anesthesiologists (ASA) physical status I, II, or III, and not suffering from any chronic pain condition. Group S patients received spinal anesthetics and no additional analgesic treatments. Group T patients received TAPB, and Group Q patients received QLB as analgesic technique in addition to spinal anesthetics.

Results

The pain scores at 6 hours (VAS 6) and 24 hours (VAS 24) were significantly different between groups (p < 0.01). Additionally, the sensory and motor block levels were significantly different between groups (p < 0.05). Multiple comparison tests showed that patients in Group Q had significantly higher sensory and motor block levels (p < 0.01 compared with Group S; p < 0.05 compared with Group T). Opioid consumption was significantly different between Groups Q and S (p < 0.01) after surgery.

Conclusions

Our findings show that both blocks are similarly effective for the management of postoperative pain compared to spinal anesthesia alone for inguinal hernia repair. We found that QLB resulted in a significant cranial spread compared to TAPB. Opioid consumption in QLB was significantly lower than that in controls but similar to that in TAPB.

Keywords
Postoperative pain; Inguinal hernia; Quadratus lumborum plane block; Transversus abdominis plane block; Spinal anesthesia

	Group S	Group T	Group Q	p-values
Gender (M/F) (n)	19/9	19/9	21/0	0.344^a a Contingency table analysis.
Age (years) (mean ± SD)	60.9 ± 13.8	50.7 ± 17.8	58.1 ± 16.6	0.114^b b Kruskal-Wallis H test.
Weight (kg) (mean ± SD)	76.6 ± 7.6	73.4 ± 13.4	76 ± 11.8	0.563^c c ANOVA.
Duration of surgery (min) (mean ± SD)	89.8 ± 30.5	89.8 ± 29.9	92.1 ± 20.4	0.571^b b Kruskal-Wallis H test.
ASA (I/II/III) (n)	2/19/0	6/15/0	2/17/2	0.104^a a Contingency table analysis.

	Group S (mean ± SD)	Group T (mean ± SD)	Group Q (mean ± SD)	p-values
Postoperative 0	0.10 ± 0.44	0 ± 0	0 ± 0	0.368^a a Kruskal-Wallis H test.
2^nd hour	0.67 ± 0.97	0.38 ± 0.80	0.95 ± 0.44	0.064^a a Kruskal-Wallis H test.
4^th hour	0.73 ± 1.23	0.71 ± 1.35	0.33 ± 0.80	0.100^a a Kruskal-Wallis H test.
6^th hour	1.14 ± 1.39	0.90 ± 1.14	0.43 ± 0.81	< 0.001^a a Kruskal-Wallis H test.
Group S vs. Group T				0.010^b b Mann-Whitney U test for multiple comparison analysis.
Group S vs. Group Q				< 0.001^b b Mann-Whitney U test for multiple comparison analysis.
Group Q vs. Group T				0.150^b b Mann-Whitney U test for multiple comparison analysis.
24^th hour	1.90 ± 0.77	0.95 ± 0.74	0.85 ± 0.73	< 0.001^a a Kruskal-Wallis H test.
Group S vs. Group T				< 0.001^b b Mann-Whitney U test for multiple comparison analysis.
Group S vs. Group Q				< 0.001^b b Mann-Whitney U test for multiple comparison analysis.
Group Q vs. Group T				0.67^b b Mann-Whitney U test for multiple comparison analysis.

Sociedade Brasileira de Anestesiologia (SBA) Rua Professor Alfredo Gomes, 36, Botafogo , cep: 22251-080 - Rio de Janeiro - RJ / Brasil , tel: +55 (21) 97977-0024 - Rio de Janeiro - RJ - Brazil
E-mail: editor.bjan@sbahq.org

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[1] * Corresponding author. onurokur@live.com

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Posterior quadratus lumborum versus transversus abdominis plane block for inguinal hernia repair: a prospective randomized controlled study☆ ☆ This study was conducted in main theaters of the Izmir Bozyaka Training and Research Hospital.

Abstract

Background and objectives

Methods

Results

Conclusions

Posterior quadratus lumborum versus transversus abdominis plane block for inguinal hernia repair: a prospective randomized controlled study^☆ ☆ This study was conducted in main theaters of the Izmir Bozyaka Training and Research Hospital.