Transplant Trial Watch

Randomized controlled trial of a quadratus lumborum block with liposomal bupivacaine for post-operative analgesia in laparoscopic donor nephrectomy.

Gritsch, H. A., et al.

Clinical Transplantation 2021 [record in progress]


Aims
This study aimed to investigate the effectiveness of a liposomal bupivacaine transmuscular quadratus lumborum (QL) block for post-operative analgesia in patients undergoing laparoscopic donor nephrectomy.

Interventions
Participants were randomised to receive either standard care including transversus abdominus plane (TAP) block, or standard care plus quadratus lumborum (QL) block intraoperatively.

Participants
103 patients undergoing laparoscopic donor nephrectomy.

Outcomes
The primary endpoints were postoperative pain scores. The secondary endpoints included requirement of pain medication, postoperative nausea and vomiting, satisfaction with pain management and complications related to QL block.

Follow-up
90 days post-surgery.

CET Conclusions
This single-centre study randomised patients undergoing laparoscopic living donor nephrectomy to either standard care (transversus abdominus (TA) block) or standard care plus quadratus lumborum (QL) block intraoperatively. Patients and outcome assessors were blinded, although surgeons were not. There was no difference in postoperative pain scores, nausea or length of stay between groups, although opioid use on day one was lower in the QL block group. Overall, these results suggest that QL block is safe in this patient cohort but may not add much benefit over a standard TA block. It is worth noting that 7 patients in the control group versus 1 patient in the study group did not receive ketorolac as per protocol. This was at the discretion of the surgeon, who was not blinded to treatment arm, suggesting possible bias that could have been avoided by using a placebo block in the control arm.

Jadad score
2

Data analysis
Per protocol analysis

Allocation concealment
No

Trial registration
ClinicalTrials.gov - NCT03294109

Funding source
Not reported