The effects of preoperative quadratus lumborum block application on postoperative pain in inguinal hernia repair: our retrospective experience

Yıl 2018, Cilt: 10 Sayı: 3, 317 - 321, 30.09.2018

Ertugrul Kılıc

https://doi.org/10.21601/ortadogutipdergisi.419968

Öz

Aim:
Quadratum lumborum block II (QL II) is a method used
for pain control after abdominal surgeons. In this study, we aimed to
retrospectively investigate the effect of ultrasound-guided QL II on
postoperative analgesia and opioid consumption in Inguinal Hernia repair
surgery (IHC) operations under general anesthesia.

Material
and Method: This
retrospective study was carried out retrospectively with the files of patients
with IHC under general anesthesia in our clinic between 01.01.2018 and 01.04.2018.
The patients who were under general anesthesia divided two groups. QL-used
(group Q) and unused (group G) patients. Pain levels measured by postoperative
visual analog scale (VAS) and consumption of opioid were recorded according of
their file knowledges.

Result:
Postoperative VAS at 2, 4, 8 and 12 hours group G
was statistically significantly higher. Postoperative total opioid consumption
was statistically higher in group G. Postoperative opioid first using time was
statistically prolonged in group Q.

Conclusions:
For result of this retrospectively designed study
was observed that inguinal hernia operations were effective in QL pain control
in the first 24 hours postoperatively. Prolonging opioid first using time also
reducing opioid consumption.

Anahtar Kelimeler

Inguinal hernia, postoperative analgesia, quadratum Lumborum block

İnguinal herni onarımında preoperatif quadratus lumborum blok uygulamasının postoperatif ağrı üzerine etkileri: retrospektif deneyimlerimiz

Öz

Amaç:
Quadratum lumborum bloğu II (QL II) batın
cerrahilerden sonra ağrı kontrolü için kullanılmakta olan bir yöntemdir. Bu
çalışmada, ultrasound eşliğinde yapılan QL II nin genel anestezi altında
yapılan İnguinal Herni onarımı cerrahisi (IHC) operasyonlarında postoperatif
analjezi ve opioid tüketimine etkisini retrospektif olarak incelemeyi
amaçladık.

Gereç ve Yöntem: Retrospektif olarak planlanan bu çalışma 01 0cak
2018 ile 01 Nisan 2018 tarihleri arasında kliniğimizde genel anestezi altında
IHC olan hastaların dosyaları geriye dönük olarak taranarak yapıldı.

Genel anesteziye ek olarak QL II uygulanan (grup Q)
ve uygulanmayan (grup G) hastalar olarak iki grupta incelendi. Bu
hastaların vizüel analog skala (VAS)  ile
ağrı düzeyleri, analjezik tüketimleri ve analjezik ilk kullanım zamanı dosya
incelenmesine göre kayıt altına alındı.

Bulgular:
Postoperatif 
VAS 2., 4., 8., ve 12. saat lerde grup G da istatistiksel olarak anlamlı
düzeyde daha yüksekti. Postoperatif toplam opioid tüketimi ise grup G de
istatistiksel olarak anlamlı düzeyde daha yüksekti. Postoperatif ilk opioid
kullanım zamanı grup G da istatistiksel olarak anlamlı düzeyde daha kısa sürede
idi.

Sonuç:
Retrospektif olarak dizayn edilen bu çalışmaya göre
inguinal herni operasyonlarında QL II postoperatif ilk 24 saatte ağrı kontrolünde
etkili olduğunu, opioid ilk kullanım zamanını uzattığını ve opioid tüketimini
azalttığını düşünmekteyiz.

Anahtar Kelimeler

İnguinal herni, postoperatif analjezi, quadratum lumborum blok

Kaynakça

• 1. Khetarpal R, Chatrath V, Kaur A, Jassi R, Verma R. Comparison of Spinal Anesthesia and Paravertebral Block in Inguinal Hernia Repair. Anesth Essays Res 2017; 11: 724-9.
• 2. Blanco R. Tap block under ultrasound guidance: the description of a ‘no pops’ technique. Reg. Anesth Pai Med 2007; 32: 130.
• 3. Sauter AR, Uullensvang K, Bendtsen TF, Brglum J, Pripp AR, Romundstad L. The Shamrock blockade-the minimum effective local anaesthetic volüme for a new ultrasound- guided lumbar plexus technique. Eur J Anaesthesiol 2015; 32: 1-7.
• 4. Børglum J, Moriggl B, Jensen K, et.al. Ultrasound-guided transmuscular quadratus lumborum blockade. Br J Anaesth 2013 (doi:10.1093/bja/el_9919).
• 5. Baidya DK, MaitraS, Arora MK, Agarwal A. Quadratus lumborum block: an effective metod of perioperative analgesia in children undergoing pyeloplasty. J. Clin Anesth 2015; 27: 694-6.
• 6. Faas CL, Acosta FJ, Campbell MD, O'Hagan CE, Newton SE, Zagalaniczny K. The effects of spinal anesthesia vs epidural anesthesia on 3 potential postoperative complications: pain, urinary retention, and mobility following inguinal herniorrhaphy. AANA J 2002; 70: 441-7.
• 7. Bhattacharya P, Mandal MC, Mukhopadhyay S, Das S, Pal PP, Basu SR. Unilateral paravertebral block: an alternative to conventional spinal anaesthesia for inguinal hernia repair. Acta Anaesthesiol Scand 2010; 54: 246-51.
• 8. Tammam TF, Salama AF. Laparoscopic-guided psoas blockade as a novel analgesic method during inguinal herniorrhaphy: a clinical trial. Acta Anaesthesiol Scand. 2017; 61: 232-40.
• 9. Sinha SK, Brahmchari Y, Kaur M, Jain A. The comparative evaluation of safety and efficacy of unilateral paravertebral block with conventional spinal anaesthesia for inguinal hernia repair. Indian J Anaesth 2016; 60: 499-505.
• 10. Law LS, Tan M, Bai Y, Miller TE, Li YJ, Gan TJ. Paravertebral Block for Inguinal Herniorrhaphy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Anesth Analg 2015; 121: 556-69.
• 11. Blanco R, Ansari T, Girgis E. Quadratus Lumborum Block for Postoperative pain after Caesarean Section: A Randomised Controlled Trial. Eur J Anaesthesiol 2015; 32: 812-8.
• 12. 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.
• 13. La Colla L, Uskova A, Ben-David B. Single-shot Quadratus Lumborum Block for Postoperative Analgesia After Minimally Invasive Hip Arthroplasty: A New Alternative to Continuous Lumbar Plexus Block? Reg Anesth Pain Med 2017; 42: 125-6.
• 14. Mullins CF, O'Brien C, O'Connor TC. Novel use of combination of electromyography and ultrasound to guide quadratus lumborum block after open appendicectomy. BMJ Case Reports 2017 (doi:10.1136/bcr-2017-219680).
• 15. Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol 2013; 29: 550-2.
• 16. Cardoso JM, Sá M, Reis H, et.al. Type II Quadratus Lumborum block for a sub-total gastrectomy in a septic patient. Rev Bras Anestesiol 2018; 68: 186-9.
• 17. Graça R, Miguelez P, Cardoso JM, et.al. Continuous quadratus lumborum type II block in partial nephrectomy . Rev Bras Anestesiol. 2018 (doi: 10.1016/j.bjan.2018.03.001).
• 18. Kaki AM, Al Marakbi W. Post-herniorrhaphy infiltration of tramadol versus bupivacaine for postoperative pain relief: a randomized study. Ann Saudi Med 2008; 28: 165-8.
• 19. Mentes O, Bagci M. Postoperative pain management after inguinal hernia repair: lornoxicam versus tramadol. Hernia 2009; 13: 427-30.