Efficacy of ultrasound guided quadratus lumborum plane-1 block for post operative analgesia at iliac / hypogastric donor sites in patients undergoing reconstructive surgery with graft harvest from dermatomal area t7 - l1 : A prospective randomised controlled study

Abstract

Background: Ultrasound-guided quadratus lumborum plane-1 (QLP-1) block involves placement of local anesthetic lateral to the quadratus lumborum muscle. It provides better and long-lasting analgesia than transverse abdominis plane block due to the spread of local anesthetic more posteriorly along the thoracolumbar fascial plane, thus involving the L1 dermatomal area. Objectives: We conducted a study to evaluate the efficacy of ultrasound-guided QLP-1 block for postoperative analgesia at iliac/hypogastric donor sites in patients undergoing reconstructive surgery with graft harvest from dermatomal area T7-L1. Materials and Methods: After obtaining approval from the ethical committee, a randomized controlled trial was conducted from February 2018 to November 2018. Eighty patients were randomly allocated into two equal groups, Group A (QLP-1 block) and Group B (control, without any block, and only iv analgesics) based on computer-generated random number techniques. Twenty ml of local anesthetic mixture containing 0.5% bupivacaine and 2% lignocaine with adrenaline and 4 mg of dexamethasone was for QLP-1 block in Group A. Aim was to assess pain scores every second hourly up to 24 h and secondary objective was the requirement of rescue analgesia. SPSS version 19 was used to derive statistical results. The unpaired t-test is used for quantitative analysis. Results: The numerical pain score (NPS) was significantly low in Group A compared to Group B between 6th and 12th h after the block (P < 0.001). The mean time at which first rescue analgesia had to be given was significantly later in group A (15.55 h) compared to Group B (6.25 h). The requirement of double rescue analgesia in the first 24 h after the block was higher in Group B (100%) compared to Group A (0%). Conclusion: Ultrasound-guided QLP-1 block is safe, hemodynamically stable, and provided superior analgesia at iliac/hypogastric donor sites compared to control group in patients undergoing reconstructive surgery with graft harvest from dermatomal area T7-L1. The number of rescue analgesics required in the QLP-1 group is less compared to the control group.

Keywords

• pain management
• postoperative pain
• quadratus lumborum block
• regional anaesthesia