POSTOPERATIVE ANALGESIA IN KIDNEY TRANSPLANT LAPAROTOMY: QUADRATUS LUMBORUM BLOCK AS AN ALTERNATIVE

  • DITA ADITIANINGSIH Department of Anesthesiology and Intensive Care, Universitas Indonesia–Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • PRYAMBODHO Department of Anesthesiology and Intensive Care, Universitas Indonesia–Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • RONALD CHRISTIAN AGUSTINUS ARITONANG Department of Anesthesiology and Intensive Care, Universitas Indonesia–Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • ERIKA SASHA ADIWONGSO Department of Anesthesiology and Intensive Care, Universitas Indonesia–Cipto Mangunkusumo General Hospital, Jakarta, Indonesia

Abstract

Objective: Effective postoperative pain management promotes better recovery. Continuous epidural (CE) is the standard postoperative analgesia for kidney transplantation; however, patients still report pain and unfavorable side effects. This present study compares the effectiveness of quadratus lumborum block (QLB) versus CE for managing pain and reducing morphine requirements following kidney transplantation.


Methods: This randomized-controlled study compared 37 kidney transplant patients: a QLB group (N=19) who received 20 ml 0.375% ropivacaine injection bilaterally and a CE group (N=18) who received 0.2% ropivacaine epidurally by infusion at 6 ml/h. Participants were assessed at 2, 6, 12, and 24h postoperatively for morphine requirements and with a visual analogue scale (VAS) for pain while resting and moving.


Results: The VAS scores when resting and moving were similar for both QLB and CE at all time points (p>0.05 for both treatments). Postoperative morphine requirements also did not differ (p>0.05) between the two groups at any time point. Both groups had similar first-time morphine requirements (802.63 min for QLB vs 871.39 min for CE, p=0.814). Both groups achieved 100% blockade at the level of T10–L1 and had comparable Bromage and Ramsay scores.


Conclusion: QLB appears to be a viable alternative approach to CE for pain management after kidney transplantation.

Keywords: Continuous epidural, Kidney transplant, Postoperative analgesia, Quadratus lumborum

References

1. Mochtar CA, Alfarissi F, Soeroto AA, Hamid ARAH, Wahyudi I, Marbun MBH, et al. Milestones of kidney transplantation in Indonesia. Med J Indones 2017;26:229–36.
2. Kakaei F, Nikeghbalian S, Malekhosseini SA. Kidney transplantation techniques. In: Rath T. editor. Current issues and future direction in kidney transplantation. Rijeka, Croatia: InTech; 2013. p. 167–84.
3. Pham PC, Khaing K, Sievers TM, Pham PM, Miller JM, Pham SV, et al. 2017 update on pain management in patients with chronic kidney disease. Clin Kidney J 2017;10:688–97.
4. Abdelsalam KMA, Sultan SS. Effectiveness of ultrasound-guided transversus abdominis plane block for intraoperative and postoperative analgesia in kidney transplantation. Ain-Shams J Anaesthesiol 2015;8:140–3.
5. Srivastava D, Tiwari T, Sahu S, Chandra A, Dhiraaj S. Anaesthetic management of renal transplant surgery in patients of dilated cardiomyopathy with ejection fraction less than 40%. Anesthesiol Res Pract 2014:1–5. Doi:10.1155/2014/525969
6. Martinez BS, Gasanova I, Adesanya A. Anesthesia for kidney transplantation-a review. J Anesth Clin Res 2013;4:270.
7. Hirata ES, Baghin MF, Pereira RI, Alves Filho G, Udelsmann A. Influence of the anesthetic technique on the hemodynamic changes in renal transplantation. a retrospective study. Rev Braz Anesthesiol 2009;59:166–76.
8. Aulakh NK, Garg K, Bose A, Aulakh BS, Chahal HS, Aulakh GS. Influence of hemodynamics and intra-operative hydration on the biochemical outcome of renal transplant recipients. J Anaesthesiol Clin Pharmacol 2015;31:174–9.
9. Blanco R, Ansari T, Riad W, Shetty N. Quadratus lumborum block versus transversus abdominis plane block for postoperative pain after cesarean delivery: a randomized controlled trial. Reg Anesth Pain Med 2016;41:757–62.
10. Ueshima H, Otake H, Lin JA. Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. Biomed Res Int 2017:1–7. Doi:10.1155/2017/2752876.
11. Krohg A, Ullensvang K, Rosseland LA, Langesæter E, Sauter AR. The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery: a randomized clinical trial. Anesth Analg 2018;126:559–65.
12. Mieszkowski MM, Mayzner Zawadzka E, Tuyakov B, Mieszkowska M, ?ukowski M, Wasniewski T, et al. Evaluation of the effectiveness of the quadratus lumborum block type I using ropivacaine in postoperative analgesia after a cesarean section - a controlled clinical study. Ginekol Pol 2018;89:89–96.
13. Rahendra R, Pryambodho P, Aditianingsih D, Sukmono RB, Tantri A, Melati AC. Comparison of IL-6 and CRP concentration between quadratus lumborum and epidural blockade among living kidney donors: a randomized controlled trial. Anesthesiol Pain Med 2019;9:e91527.
14. Blanco R, Ansari T, Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: a randomized controlled trial. Eur J Anaesthesiol 2015;32:812-8.
15. Murouchi T, Iwasaki S, Yamakage M. Quadratus lumborum block: analgesic effects and chronological ropivacaine concentrations after laparoscopic surgery. Reg Anesth Pain Med 2016;41:146–50.
16. Dam M, Moriggl B, Hansen CK, Hoermann R, Bendtsen TF, Børglum J. The pathway of injectate spread with the transmuscular quadratus lumborum block: a cadaver study. Anesth Anal 2017;125:303–12.
17. Yousef NK. Quadratus lumborum block versus transversus abdominis plane block in patients undergoing total abdominal hysterectomy: a randomized prospective controlled trial. Anesth Essays Res 2018;12:742–7.
18. Macintyre PE. Safety and efficacy of patient-controlled analgesia. Br J Anaesth 2001;87:36–46.
19. Aubrun F, Mazoit JX, Riou B. Postoperative intravenous morphine titration. Br J Anaesth 2012;108:193–201.
20. Elsharkawy H, El-Boghdadly K, Barrington M. Quadratus lumborum block: anatomical concepts, mechanisms, and techniques. Anesthesiology 2019;130:322–35.
21. Karmakar MK. Thoracic paravertebral block. Anesthesiology 2001;95:771–80.
22. Kuthiala G, Chaudhary G. Ropivacaine: a review of its pharmacology and clinical use. Indian J Anaesth 2011;55:104–10.
23. Hong JM, Lee HJ, Oh YJ, Cho AR, Kim HJ, Lee DW, et al. Observations on significant hemodynamic changes caused by a high concentration of epidurally administered ropivacaine: correlation and prediction study of stroke volume variation and central venous pressure in thoracic epidural anesthesia. BMC Anesthesiol 2017;17:153.
24. Brull R, MacFarlane A, Chan V. Spinal, epidural, and caudal anesthesia. In: Miller R, Eriksson L, Fleisher L, Wiener Kronish J, Cohen N, Young W. editors. Miller’s anesthesia. 8th ed. Philadelphia: Elsevier-Saunders 2015. p. 1684–720.
25. Schnuelle P, Gottmann U, Köppel H, Brinkkoetter PT, Krzossok S, Weiss J, et al. Comparison of early renal function parameters for the prediction of 5 y graft survival after kidney transplantation. Nephrol Dial Transplant 2007;22:235–45.
Statistics
4 Views | 18 Downloads
How to Cite
ADITIANINGSIH, D., PRYAMBODHO, ARITONANG, R. C. A., & ADIWONGSO, E. S. (2020). POSTOPERATIVE ANALGESIA IN KIDNEY TRANSPLANT LAPAROTOMY: QUADRATUS LUMBORUM BLOCK AS AN ALTERNATIVE. International Journal of Applied Pharmaceutics, 12(3). Retrieved from https://innovareacademics.in/journals/index.php/ijap/article/view/39465
Section
Full Proceeding Paper