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Background <p>The analgesic efficacy of transmuscular quadratus lumborum block (TQLB) as a means of decreasing the need for opioid use following laparoscopic nephrectomy has been demonstrated in several studies, but the effect of the lower thoracic paravertebral block via posterior pathway of medial arcuate ligament under direct visualization (LTPB-MAL) in this surgical context remains to be clearly elucidated.</p> Objectives <p>To juxtapose the pain-relieving potency of the TQLB and the LTPB-MAL in individuals receiving laparoscopic nephrectomy.</p> Design <p>A randomized controlled study.</p> Setting <p>University-affiliated tertiary care hospital.</p> Methods <p>One hundred and two individuals slated for laparoscopic nephrectomy under general anesthesia were assigned to acquire either TQLB or LTPB-MAL by chance, with both groups receiving 25&#xa0;ml of 0.5% ropivacaine post-surgery. The primary outcome was the total intravenous morphine equivalent doses consumed within the first day post-operatively. Secondary outcomes included pain intensity; interval to first opioids request; rescue analgesics use; and occurrence of nausea/vomiting; time to first ambulation; hospital duration and satisfaction scores.</p> Results <p>The patients receiving LTPB-MAL consumed significantly less intravenous morphine equivalent doses than those receiving TQLB in the first 24&#xa0;h after surgery, with a mean (SD) of 23.5 (7.6) mg versus 33.6 (10.2) mg, <i>P</i> &lt; 0.001, respectively. Time to the first opioid request in the LTPB-MAL group was significantly prolonged compared with the TQLB group, <i>P</i> &lt; 0.001. No considerable discrepancy was observed in pain intensity, rescue pain consumption, satisfaction scores, incidence of nausea or vomiting, or ambulation and length of hospital stay within the two groups.</p> Conclusion <p>LTPB-MAL significantly reduces postoperative opioids usage in the first 24&#xa0;h after surgery and delays the initial opioid request, endorsing it as an enhanced strategy for multimodal analgesia in laparoscopic nephrectomy.</p> Trial registration <p>The Ethics Committee of Beijing Chaoyang Hospital granted ethical approval for our study protocol on May 10, 2022 (2022-ke-447). The study was officially registered with the Chinese Clinical Trial Registry (ChiCTR2200060507) on June 3, 2022.</p>

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Lower thoracic paravertebral block via posterior pathway of medial arcuate ligament under direct visualization versus transmuscular quadratus lumborum block for postoperative analgesia following retroperitoneal laparoscopic nephrectomy: a randomized controlled trial

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  • 发表日期：

    2025年10月29日

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  • Zhangran Ai,
  • Huili Li,
  • Xiaoyong Yang,
  • Rong Shi,
  • Peiqi Shao,
  • Songchao Xu,
  • Ruijuan Guo,
  • Danxu Ma,
  • Yun Wang

摘要

Background

The analgesic efficacy of transmuscular quadratus lumborum block (TQLB) as a means of decreasing the need for opioid use following laparoscopic nephrectomy has been demonstrated in several studies, but the effect of the lower thoracic paravertebral block via posterior pathway of medial arcuate ligament under direct visualization (LTPB-MAL) in this surgical context remains to be clearly elucidated.

Objectives

To juxtapose the pain-relieving potency of the TQLB and the LTPB-MAL in individuals receiving laparoscopic nephrectomy.

Design

A randomized controlled study.

Setting

University-affiliated tertiary care hospital.

Methods

One hundred and two individuals slated for laparoscopic nephrectomy under general anesthesia were assigned to acquire either TQLB or LTPB-MAL by chance, with both groups receiving 25 ml of 0.5% ropivacaine post-surgery. The primary outcome was the total intravenous morphine equivalent doses consumed within the first day post-operatively. Secondary outcomes included pain intensity; interval to first opioids request; rescue analgesics use; and occurrence of nausea/vomiting; time to first ambulation; hospital duration and satisfaction scores.

Results

The patients receiving LTPB-MAL consumed significantly less intravenous morphine equivalent doses than those receiving TQLB in the first 24 h after surgery, with a mean (SD) of 23.5 (7.6) mg versus 33.6 (10.2) mg, P < 0.001, respectively. Time to the first opioid request in the LTPB-MAL group was significantly prolonged compared with the TQLB group, P < 0.001. No considerable discrepancy was observed in pain intensity, rescue pain consumption, satisfaction scores, incidence of nausea or vomiting, or ambulation and length of hospital stay within the two groups.

Conclusion

LTPB-MAL significantly reduces postoperative opioids usage in the first 24 h after surgery and delays the initial opioid request, endorsing it as an enhanced strategy for multimodal analgesia in laparoscopic nephrectomy.

Trial registration

The Ethics Committee of Beijing Chaoyang Hospital granted ethical approval for our study protocol on May 10, 2022 (2022-ke-447). The study was officially registered with the Chinese Clinical Trial Registry (ChiCTR2200060507) on June 3, 2022.