Safety and Efficacy of Ultrasound-Guided Retrolaminar Block of Multiple Injections in Retroperitoneal Laparoscopic Nephrectomy: A Prospective Randomized Controlled Study

Abstract

Dexing Liu,1,2 Xinpeng Xu,2 Yuhang Zhu,2 Xingxing Liu,1,2 Faliang Zhao,1,3 Guobiao Liang,1,3 Zhaoqiong Zhu1,2 1Soochow University Medical College, Suzhou, 215000, People’s Republic of China; 2Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, People’s Republic of China; 3Department of Urology, Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, People’s Republic of ChinaCorrespondence: Zhaoqiong Zhu Email [email protected]: Ultrasound-guided retrolaminar block (RLB) has the potential to provide postoperative analgesia in retroperitoneal laparoscopic surgery. This study was conducted to evaluate the effects of RLB when compared with local infiltration analgesia (LIA) in retroperitoneal laparoscopic nephrectomy.Patients and Methods: One hundred and fifteen patients scheduled for laparoscopic nephrectomy were divided into two groups: the RLB group (n = 57) received an ultrasound-guided RLB, while the LIA group (n = 58) received LIA. At 2, 4, 6, 24, and 48 hours after operation, the maximal visual analog score (VAS), sufentanil and rescue analgesia consumption, and the utilization of patient-controlled intravenous analgesia (PCIA) were assessed. The incidence rates of postoperative nausea and vomiting (PONV); time of leaving bed (at the first instance); and the levels of plasma β-Endorphin (β-EP), Interleukin-1β (IL-1β), and prostaglandin E2 (PEG2) 30 min after extubation were noted.Results: Patients in the RLB group had significantly lower VAS scores; lower sufentanil cumulative consumption; lower manual addition frequency of PCIA; lower proportion of using rescue analgesia within 48 hours after operation; lower incidence rate of PONV; shorter resuscitation times; earlier time of leaving the bed; and lower β-EP, IL-1 β, and PEG2 levels.Conclusion: Ultrasound-guided RLB of multiple injections is both safe and controllable for postoperative analgesia after retroperitoneal laparoscopic nephrectomy. When compared with LIA, RLB has better and longer-lasting analgesic effect, lower incidence rates of PONV, and the potential to reduce the level of postoperative inflammatory factors.Trial Registration: China Clinical Trials Registration Center (http://www.chictr.org.cn, No. ChiCTR1800017526, Date of registration: 2018– 08-02).Keywords: ultrasound guidance, retrolaminar block, retroperitoneal laparoscopic nephrectomy, local infiltration anesthesia

Keywords

• ultrasound guidance
• retrolaminar block
• retroperitoneal laparoscopic nephrectomy
• local infiltration anesthesia