Background: Quadratus lumborum block (QLB) is an effective analgesia that lowers opioid consumption after\nlower abdominal and hip surgeries. The subcostal approach to transmuscular QLB is a novel technique that can\nprovide postoperative analgesia by blocking more dermatomes. The aim of this study is to evaluate the efficacy\nand viability of subcostal approach to QLB after laparoscopic nephrectomy.\nMethods: Sixty patients who underwent laparoscopic nephrectomy were randomly divided into the subcostal\napproach to QLB group (QLB group, n = 30) and the control group (C group, n = 30). All patients underwent\nultrasound-guided subcostal approach to QLB in an ipsilateral parasagittal oblique plane at the L1â??L2 level. The QLB\ngroup received 0.4 cc/kg of 0.3% ropivacaine, and the C group received 0.4 cc/kg of 0.9% saline. Postoperatively, a\npatient-controlled intravenous analgesic pump with sufentanil was attached to all the patients. The primary outcome\nwas sufentanil consumption within the first 24 h after surgery. The secondary outcomes included the Ramsey\nsedation scale (RSS) scores and Bruggemann comfort scale (BCS) scores 6 h (T1), 12 h (T2), and 24 h (T3) after surgery,\nintraoperative remifentanil consumption, number of patients requiring rescue analgesia, time to recovery of intestinal\nfunction, mobilization time after surgery, and presence of side effects.\nResults: Sufentanil consumption within the first 24 h after surgery was significantly lower in the QLB group than in the\nC group (mean [standard deviation]: 34.1 [9.9] microg vs 42.1 [11.6] microg, P = .006). The RSS scores did not differ between the\ntwo groups, and the BCS scores of the QLB group at T1 and T2 time points was significantly higher than those of the C\ngroup(P<0.05). The consumption of remifentanil intraoperatively and the number of patients requiring rescue analgesia\nwere significantly lower in the QLB group (P<0.05). Time to recovery of intestinal function and mobilization time after\nsurgery were significantly earlier in the QLB group (P<0.05). The incidence of postoperative nausea and vomiting was\nsignificantly lower in the QLB group (P<0.05).\nConclusions: The ultrasound-guided subcostal approach to QLB is an effective analgesic technique in patients\nundergoing laparoscopic nephrectomy as it reduces the consumption of sufentanil postoperatively.
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