Quadratus Lumborum Block vs Transversus Abdominis Plane Block for Post-cholecystectomy Analgesia
Status:
Completed
Trial end date:
2018-03-15
Target enrollment:
Participant gender:
Summary
In laparoscopic cholecystectomy, overall pain is a conglomerate of three different and
clinically separate components: incisional pain (somatic pain) due to trocar insertion sites,
visceral pain (deep intra abdominal pain), and shoulder pain due to peritoneal stretching and
diaphragmatic irritation associated with carbon dioxide insufflation. Moreover, it has been
hypothesized that intense acute pain after laparoscopic cholecystectomy may predict
development of chronic pain (e.g., postlaparoscopic cholecystectomy syndrome). Without
effective treatment, this ongoing pain may delay recovery, mandate inpatient admission, and
thereby increase the cost of such care.
Recently, the uses of peripheral axial blocks that deliver local anesthetic into the
transversus abdominis fascial plane have become popular for operations that involve
incision(s) of the abdominal wall. Thus, the Transversus Abdominis plane (TAP) block has been
shown to reduce perioperative opioid use in elective abdominal surgery, including open
appendicectomy, laparotomy, and laparoscopic cholecystectomy. However, the efficacy of the
TAP block is reportedly only reliable in providing analgesia below the umbilicus. The
ultrasound-guided subcostal transversus abdominis (STA) block is a recently described
variation on the TAP block which produces reliable supraumbilical analgesia. Deposition of
local anesthetic in this plane has shown to block dermatomes T6 to T10 with an occasional
spread to T12. This variant will be discussed in our study.
Currently, the Quadratus Lumborum block (QL block) is performed as one of the perioperative
pain management procedures for all generations (pediatrics, pregnant, and adult) undergoing
abdominal surgery. The local anesthetic injected via the approach of the posterior QL block (
QL 2 block ) can more easily extend beyond the TAP to the thoracic paravertebral space or the
thoracolumbar plane, the posterior QL block entails a broader sensory-level analgesic and may
generate analgesia from T7 to L1. Use of posterior QL block in laparoscopic cholecystectomy
has not been investigated before and it is the variant that will be discussed in our study.