Ultrasound-Guided Anterior Quadratus Lumborum Block at Lateral Supra-Arcuate Ligament vs Thoracic Epidural Analgesia after Open Liver Surgery: A Randomized, Controlled, Noninferiority Trial

doi:10.1097/XCS.0000000000000354

	Ultrasound-Guided Anterior Quadratus Lumborum Block at Lateral Supra-Arcuate Ligament vs Thoracic Epidural Analgesia after Open Liver Surgery: A Randomized, Controlled, Noninferiority Trial
	Gu, Bin 1; Zhou, Huidan 1; Lian, Yanhong 1; Zhou, Yiming 2; He, Shuang 1; Xie, Kangjie 1; Jiang, Huifang 1,3
刊名	JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
	2022-12-01
卷号	235
ISSN号	1072-7515
DOI	10.1097/XCS.0000000000000354
通讯作者	Jiang, Huifang(jhfang0128@126.com)
英文摘要	BACKGROUND: Thoracic epidural analgesia (TEA) has demonstrated great analgesic benefits in open liver surgery. However, the increased risk of postoperative coagulopathy after open liver surgery has promoted interest in alternate analgesic research. We aimed to explore whether ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament (LAL-QLB) with intravenous analgesia was noninferior to TEA under multimodal analgesia after open liver surgery. STUDY DESIGN: Seventy-four patients undergoing open liver surgery were randomized (1:1) to the LAL-QLB or TEA group in this open-label study. The primary outcome was the numeric rating scale during coughing at 24 hours postoperatively with a noninferiority limit of 1. RESULTS: The mean difference of numeric rating scale during coughing at 24 hours postoperatively was 0.32 (95% CI -0.03 to 0.68), showing noninferiority. The TEA group had better pain scores at 1 and 6 hours, and the early postoperative pain of the LAL-QLB group was within the clinically acceptable limit with no differences at other time points. The LAL-QLB group received more opioids within 24 hours postoperatively. There were no differences in analgesia-related adverse reactions or rescue analgesia. Postoperative coagulopathy was responsible with 19.4% of delayed epidural removal. TEA outperformed LAL-QLB in terms of ambulation and bowel recovery. There were no differences in hospital stay or 30-day postoperative complications. CONCLUSIONS: LAL-QLB provided noninferior analgesia at 24 hours postoperatively. Despite regarding coagulopathy and delayed epidural removal, TEA was found to be better than LAL-QLB for pain management after open liver surgery. Epidural removal required close coagulation test. (C) 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.
资助项目	Medical Science and Technology Project of Zhejiang Province , Hangzhou, Zhejiang, China[2020KY065] ; Medical Science and Technology Project of Zhejiang Province , Hangzhou, Zhejiang, China[2020KY075] ; Medical Science and Technology Project of Zhejiang Province , Hangzhou, Zhejiang, China[2020KY076]
WOS关键词	ABDOMINIS PLANE BLOCK ; ENHANCED RECOVERY ; INFILTRATION ; MECHANISMS ; ANESTHESIA
WOS研究方向	Surgery
语种	英语
出版者	LIPPINCOTT WILLIAMS & WILKINS
WOS记录号	WOS:000885371100011
资助机构	Medical Science and Technology Project of Zhejiang Province , Hangzhou, Zhejiang, China
内容类型	期刊论文
源URL	[http://ir.hfcas.ac.cn:8080/handle/334002/131588]
专题	中国科学院合肥物质科学研究院
通讯作者	Jiang, Huifang
作者单位	1.Chinese Acad Sci, Univ Chinese Acad Sci, Zhejiang Canc Hosp, Canc Hosp,Inst Basic Med & Canc IBMC,Res Ctr Neuro, Hangzhou, Zhejiang, Peoples R China 2.Chinese Acad Sci, Univ Chinese Acad Sci, Zhejiang Canc Hosp, Canc Hosp,Inst Basic Med & Canc IBMC,Dept Hepatopa, Hangzhou, Zhejiang, Peoples R China 3.Chinese Acad Sci, Univ Chinese Acad Sci, Zhejiang Canc Hosp, Canc Hosp,Inst Basic Med & Canc IBMC,Res Ctr Neuro, 1 East Banshan Rd, Hangzhou, Zhejiang, Peoples R China
推荐引用方式 GB/T 7714	Gu, Bin,Zhou, Huidan,Lian, Yanhong,et al. Ultrasound-Guided Anterior Quadratus Lumborum Block at Lateral Supra-Arcuate Ligament vs Thoracic Epidural Analgesia after Open Liver Surgery: A Randomized, Controlled, Noninferiority Trial[J]. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS,2022,235.
APA	Gu, Bin.,Zhou, Huidan.,Lian, Yanhong.,Zhou, Yiming.,He, Shuang.,...&Jiang, Huifang.(2022).Ultrasound-Guided Anterior Quadratus Lumborum Block at Lateral Supra-Arcuate Ligament vs Thoracic Epidural Analgesia after Open Liver Surgery: A Randomized, Controlled, Noninferiority Trial.JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS,235.
MLA	Gu, Bin,et al."Ultrasound-Guided Anterior Quadratus Lumborum Block at Lateral Supra-Arcuate Ligament vs Thoracic Epidural Analgesia after Open Liver Surgery: A Randomized, Controlled, Noninferiority Trial".JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 235(2022).