Comparative Study between Ultrasound Guided Anterior and Posterior Approaches of Quadratus Lumborum Block in Extracorporeal Shock Wave Lithotripsy

Document Type : Original Article

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Department of Anesthesia, Intensive Care and Pain Management, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt

Abstract

Background: Quadratus Lumborum Block [QLB] has emerged as a promising analgesic technique for providing effective pain relief during various surgical procedures. Nevertheless, the results pertaining to QLB in urological surgeries have shown variability in terms of the impact of QLB on postoperative pain relief and occurrence of side effects.
Aim of the work: This work aimed to compare the analgesic efficacy of ultrasound-guided anterior and posterior approaches of QLB for postoperative pain management in patients undergoing Extracorporeal shock wave lithotripsy [ESWL].
Patients and methods: This randomized clinical trial included 60 patients scheduled for ESWL. They were randomly allocated into two groups. Patients in group A [n=30] received ultrasound-guided anterior QLB, while group B [n=30] received posterior QLB. Visual analog scale [VAS] pain scores was assessed at 4 hours’ intervals for 24 hours and additional analgesic requirement in first 24 hours were recorded.
Results: Regarding the Visual Analog Scale [VAS], there was no statistically significant distinction between groups in terms of pain alleviation within the initial 12 hours after surgery [P > 0.05]. However, group A exhibited notably superior pain relief compared to group B from 12 to 24 hours postoperatively [P < 0.001]. In terms of the Post Anesthetic Discharge Score [PADS], group A demonstrated significantly higher scores than group B from 2 to 24 hours following the surgery [P < 0.001].
Conclusion: Ultrasound-guided anterior approach of QLB provided superior postoperative analgesia compared to posterior approach in patients undergoing ESWL, as evidenced by less rescue analgesic requirement in first 24 hours. Anterior QLB can be considered the preferred technique for pain management in ESWL.

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