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Introduction <p>Quadratus lumborum block (QLB), as a trunk regional block technique, can effectively alleviate postoperative pain in renal surgery. Ultrasound-guided QLB (U-QLB) administered by anesthesiologists is one of the most commonly used techniques. Recently, QLB can be administered by surgeons with the help of laparoscopy during renal surgery. Laparoscopic-assisted QLB (L-QLB) is a new technique. However, there is still a lack of comparison between U-QLB and L-QLB. The aim of this study was to compare the analgesic effects of laparoscopic and ultrasound-guided QLB in patients undergoing laparoscopic nephrectomy.</p> Methods <p>Sixty patients undergoing laparoscopic nephrectomy were enrolled and randomized to receive L-QLB (group L) or U-QLB (group U) in a 1:1 ratio. A patient-controlled intravenous analgesia (PCIA) pump with sufentanil was administered after surgery. The primary outcome was cumulative sufentanil consumption within the first 24&#xa0;h after surgery. Secondary outcomes consisted of the procedural time of QLB; the dermatomes of sensory block 2&#xa0;h after surgery; resting and coughing visual analog scale (VAS) scores at 6, 12, 24, and 48&#xa0;h postoperatively; rescue analgesia rate during the 0–48&#xa0;h period after surgery; patient satisfaction with pain relief at 24&#xa0;h post-surgery; and adverse events.</p> Results <p>The cumulative sufentanil consumption within the first 24&#xa0;h after surgery was significantly lower in the L group (median [IQR], 50.00 [48.00–52.00] μg) than in the U group (54.00 [48.75–59.25] μg) (Mann–Whitney <i>U</i> = 276.0, <i>z</i> = –2.234, <i>P</i> = 0.026). The procedural time of QLB was significantly shorter in group L than in group U (2.8 ± 0.8 min versus. 5.6 ± 1.1&#xa0;min, mean difference (MD): 2.8&#xa0;min, 95% CI 2.29 to 3.31, <i>P</i> &lt; 0.001). Compared with the L group, the dermatomes of sensory block 2&#xa0;h after surgery were significantly lower in the U group (6.9 ± 1.0 versus 6.2 ± 1.1, MD: –0.7, 95% CI –1.25 to –0.15, <i>P</i> = 0.014). The VAS scores during rest and coughing at 6, 12, and 24&#xa0;h postoperatively were significantly lower in the L group than in the U group (<i>P</i> &lt; 0.05). However, no significant difference in VAS scores between the two groups 48&#xa0;h postoperatively was noted (<i>P</i> &gt; 0.05). Compared with the L group, the rescue analgesia rate during the 0–48&#xa0;h period after surgery was significantly higher in the U group (17.2% versus 44.8%, relative risk: 0.39, 95% CI 0.16–0.94, <i>P</i> = 0.023). Patients in group L had significantly higher satisfaction with pain relief 24&#xa0;h postoperatively than those in group U (<i>P</i> = 0.037). No significant difference in adverse events was observed between the two groups (<i>P</i> &gt; 0.05).</p> Conclusions <p>Compared with ultrasound-guided QLB, laparoscopic QLB demonstrates favorable analgesic trends within the first 24&#xa0;h after laparoscopic nephrectomy, including reduced sufentanil consumption. Furthermore, L-QLB shows a shorter procedural time, broader sensory blockade coverage, and higher patient satisfaction.</p> Trial Registration <p>Chictr.org.cn identifier, ChiCTR2400080942.</p>

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Analgesic Effect of Laparoscopic Versus Ultrasound-Guided Quadratus Lumborum Block in Patients Undergoing Laparoscopic Nephrectomy: A Randomized Controlled Clinical Trial

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  • 发表日期：

    2026年2月18日

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  • Manhua Zhu,
  • Lingzhi Wang,
  • Pingping Chen,
  • Wenfei Xu

摘要

Introduction

Quadratus lumborum block (QLB), as a trunk regional block technique, can effectively alleviate postoperative pain in renal surgery. Ultrasound-guided QLB (U-QLB) administered by anesthesiologists is one of the most commonly used techniques. Recently, QLB can be administered by surgeons with the help of laparoscopy during renal surgery. Laparoscopic-assisted QLB (L-QLB) is a new technique. However, there is still a lack of comparison between U-QLB and L-QLB. The aim of this study was to compare the analgesic effects of laparoscopic and ultrasound-guided QLB in patients undergoing laparoscopic nephrectomy.

Methods

Sixty patients undergoing laparoscopic nephrectomy were enrolled and randomized to receive L-QLB (group L) or U-QLB (group U) in a 1:1 ratio. A patient-controlled intravenous analgesia (PCIA) pump with sufentanil was administered after surgery. The primary outcome was cumulative sufentanil consumption within the first 24 h after surgery. Secondary outcomes consisted of the procedural time of QLB; the dermatomes of sensory block 2 h after surgery; resting and coughing visual analog scale (VAS) scores at 6, 12, 24, and 48 h postoperatively; rescue analgesia rate during the 0–48 h period after surgery; patient satisfaction with pain relief at 24 h post-surgery; and adverse events.

Results

The cumulative sufentanil consumption within the first 24 h after surgery was significantly lower in the L group (median [IQR], 50.00 [48.00–52.00] μg) than in the U group (54.00 [48.75–59.25] μg) (Mann–Whitney U = 276.0, z = –2.234, P = 0.026). The procedural time of QLB was significantly shorter in group L than in group U (2.8 ± 0.8 min versus. 5.6 ± 1.1 min, mean difference (MD): 2.8 min, 95% CI 2.29 to 3.31, P < 0.001). Compared with the L group, the dermatomes of sensory block 2 h after surgery were significantly lower in the U group (6.9 ± 1.0 versus 6.2 ± 1.1, MD: –0.7, 95% CI –1.25 to –0.15, P = 0.014). The VAS scores during rest and coughing at 6, 12, and 24 h postoperatively were significantly lower in the L group than in the U group (P < 0.05). However, no significant difference in VAS scores between the two groups 48 h postoperatively was noted (P > 0.05). Compared with the L group, the rescue analgesia rate during the 0–48 h period after surgery was significantly higher in the U group (17.2% versus 44.8%, relative risk: 0.39, 95% CI 0.16–0.94, P = 0.023). Patients in group L had significantly higher satisfaction with pain relief 24 h postoperatively than those in group U (P = 0.037). No significant difference in adverse events was observed between the two groups (P > 0.05).

Conclusions

Compared with ultrasound-guided QLB, laparoscopic QLB demonstrates favorable analgesic trends within the first 24 h after laparoscopic nephrectomy, including reduced sufentanil consumption. Furthermore, L-QLB shows a shorter procedural time, broader sensory blockade coverage, and higher patient satisfaction.

Trial Registration

Chictr.org.cn identifier, ChiCTR2400080942.