Pain Med. 2022 Nov 2:pnac166. doi: 10.1093/pm/pnac166. Online ahead of print.
OBJECTIVE: To evaluate the analgesic efficacy of quadratus lumborum block (QLB) in adults undergoing nephrectomy.
DESIGN: Systematic review and meta-analysis.
PATIENTS: Adult patients (≥ 18 years) received nephrectomy under general anesthesia.
METHODS: We searched PubMed, Embase, the Cochrane Library, and Web of Science on January 10, 2022, including randomized controlled trials (RCTs) that evaluated the analgesic efficacy of QLB for patients undergoing nephrectomy.
RESULTS: A total of 12 RCTs (N = 821 patients) were included in the study. Compared with the non-block, single-shot QLB reduced the postoperative opioid consumption (mean difference [MD], -8.37 mg intravenous morphine equivalent; 95% CI, -12.19 to -4.54 mg) and pain scores at 2 h, 6 h, 12 h, and 24 h at rest and during movement after nephrectomy. Single-shot QLB also prolonged the time to first analgesic request (MD, 6.44 h; 95% CI, 2.23 to 10.65 h), and shortened the length of hospital stay (MD, -0.32 d; 95% CI, -0.55 to -0.09 d) and decreased the incidence of postoperative nausea and vomiting (risk ratio, 0.48; 95% CI, 0.36 to 0.65). Compared with continuous epidural anesthesia, repeated QLB may provide comparable postoperative analgesic benefits.
CONCLUSIONS: Single-shot QLB provided a statistically significant, but clinically-small improvement in postoperative analgesia and recovery for patients undergoing nephrectomy. The QLB would be beneficial as part of multimodal analgesia. Future research may need to determine which approach of QLB is superior for postoperative analgesia after nephrectomy.