LAL-QLB with IV analgesia as good as TEA under multimodal analgesia after open liver surgery

A recent study by Bin Gu found thoracic epidural analgesia (TEA) provides better pain control than ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament (LAL-QLB) with intravenous analgesia after open liver surgery. The findings of this study was published in Journal of the American College of Surgeon.

This study was a randomized, open-label trial that included 74 patients undergoing open liver surgery who were randomized (1:1) to the LAL-QLB or TEA group. The primary outcome was the numeric rating scale during coughing at 24 hours postoperatively with a non-inferiority limit of 1.

The key highlights of the study were:

The mean difference of numeric rating scale during coughing at 24 hours postoperatively was 0.32 (95% CI –0.03 to 0.68), showing non-inferiority.

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.

The study also found that 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.

The study found that LAL-QLB provided non-inferior analgesia at 24 hours postoperatively. However, considering coagulopathy and delayed epidural removal, TEA was found to be better than LAL-QLB for pain management after open liver surgery. Close coagulation test were necessary for epidural removal.

Source:

Gu, B., Zhou, H., Lian, Y., Zhou, Y., He, S., Xie, K., & Jiang, H. (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. In Journal of the American College of Surgeons. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/xcs.0000000000000354