Quadratus lumborum block as a component of analgesia in laparoscopic cholecystectomy

Abstract

Laparoscopic cholecystectomy is a minimally invasive procedure. However, it can cause severe postoperative pain, and sometimes chronic pain. This pain results from several causes: trocar insertion, wound healing, surgical manipulation with the gallbladder and surrounding organs, inflammation, referred shoulder pain, carbon dioxide insufflation, accidental nerve damage. A combination of methods is often used to treat postoperative pain, including analgesics (nonsteroidal anti-inflammatory drugs and opioids), regional anesthesia, and proper wound care. The quadratus lumborum (QL) block is a regional anesthetic technique that can be used in laparoscopic cholecystectomy to provide postoperative analgesia. It involves injecting a local anesthetic agent into the QL muscle, which is located on the side of the lower back. Injection of a local anesthetic near the quadratus lumborum muscle can block the thoracolumbar nerves and provide pain relief in the upper and lower abdomen. QL blocks generally provide sensory block to the following dermatomes: T12, L1, L2, L3. The degree of dermatomal coverage can be influenced by factors such as the volume of local anesthetic used, the specific injection site, and individual anatomical variations. QL block provides effective pain management after abdominal surgery; helps reduce the need for opioids, which can have side effects; improves the patient’s recovery. Further research is needed to explore the long-term benefits and optimal techniques for QL block in this setting.

Keywords

• laparoscopic cholecystectomy
• pain
• analgesia
• regional anesthesia
• quadratus lumborum block