Search Results (38)

This retrospective study compared three ultrasound-guided locoregional techniques—transversus abdominis plane (TAP), quadratus lumborum (QL), and caudal thoracic paravertebral (C-TPV) blocks—in dogs undergoing laparoscopic ovariectomy. Ninety-eight dogs were included. The primary outcome was intraoperative rescue opioid requirement, while secondary outcomes included block execution time, postoperative analgesic requirements, intraoperative hypotension, and block-related complications. QL showed the shortest block execution time, followed by C-TPV and TAP. Intraoperative fentanyl requirements differed significantly among groups, with the highest requirements observed in the TAP group, intermediate values in the QL group, and the lowest in the C-TPV group. Postoperative methadone requirements were minimal across groups, with a statistically significant difference observed only between C-TPV and TAP. Rates of intraoperative hypotension and block-related complications were low and comparable among techniques. In this retrospective cohort, C-TPV was associated with lower intraoperative opioid requirements, whereas QL showed the shortest execution time. Postoperative differences were minimal and of uncertain clinical relevance. Prospective controlled studies are warranted to confirm these findings. Full article

Background and Objectives: Effective pain control after laparoscopic colorectal surgery is crucial for Enhanced Recovery After Surgery (ERAS) protocols. The transversus abdominis plane block (TAPB) provides somatic analgesia but lacks visceral coverage. The quadratus lumborum block (QLB) has emerged as an alternative, potentially offering both somatic and visceral blockade, but its superiority is debated. This systematic review and meta-analysis aimed to compare the analgesic efficacy of QLB versus TAPB in this setting. Materials and Methods: A comprehensive search of PubMed, Scopus, CENTRAL, and Web of Science was conducted for randomized controlled trials (RCTs) up to November 2025. Primary outcomes were 24 h postoperative and intraoperative opioid consumption. Secondary outcomes included pain scores, length of hospital stay (LoS), surgery duration, and adverse events. Standardized mean differences (SMD) and risk ratios (RR) were pooled. Results: Five RCTs involving 520 patients were included. No significant difference was found in 24 h postoperative opioid consumption (SMD: −1.62, 95% CI [−3.45, 0.20]; p = 0.08) or intraoperative opioid consumption (SMD: 0.38, 95% CI [−0.36, 1.12]; p = 0.31). QLB provided better, transient pain relief at rest at 12 h (SMD: −0.30, 95% CI [−0.52, −0.07]; p = 0.01) and during movement at 6 h (SMD: −0.20, 95% CI [−0.49, −0.09]; p = 0.01). No other time points for pain showed significant differences. QLB was associated with a shorter surgery duration (MD: −5.61 min, 95% CI [−10.38, −0.85]; p = 0.02), but not LoS (p = 0.53) or rates of PONV (p = 0.24) or dizziness (p = 0.32). Conclusions: With uncertain evidence, QLB and TAPB showed no significant difference in opioid consumption. QLB demonstrated a statistically significant but transient early analgesic advantage. This heterogeneity may be due to different QLB techniques, warranting further investigation. Full article

Background: The peritoneal dialysis (PD) catheter is commonly placed using an open surgery approach. However, mechanical peritoneal catheter-related complications are common causes of peritoneal dialysis technical failure. In recent years, laparoscopic procedures have been recommended because of less invasiveness and high effectiveness in reducing catheter dysfunction; however, this approach is burdened by higher costs and higher risks related to general anesthesia. Methods: We have developed a new advanced video-laparoscopy (ALS) approach with a simple technique that does not require general anesthesia. By using an ultrasound-guided procedure it is possible to place a PD catheter by regional anesthesia (Transversus Abdominis Plane (TAP) block associated with bilateral quadratus lumborum (QLB) block). Results: We here report the outcomes of 20 patients who underwent ALS implantation of straight-neck, double-cuffed Tenckhoff catheters using cutaneous anesthesia with TAP and QLB block. No major complications, including bleeding, were reported. No patient needed intravenous treatment for pain control, and all procedures were well tolerated. During a median follow-up of 21 months [IQR, 15–35] no mechanical complication was reported. Conclusions: ALS without general anesthesia is a simple and well-tolerated technique that can be used in patients at high risk. It therefore allows recruiting a greater number of patients for PD and ensuring well-performing catheters with lower risk of mechanical complications. Full article

Background and Objectives: Although various regional anesthesia techniques are commonly used for laparoscopic cholecystectomy (LC), to date, no randomized controlled trial has compared the effectiveness of Quadratus Lumborum Plane Block (QLB) and External Oblique Intercostal Plane Block (EOIPB) in LC. Our aim was to compare the effectiveness of ultrasound-guided QLB and EOIPB in providing postoperative analgesia after LC. Materials and Methods: In this two-center, randomized controlled trial, patients undergoing LC were divided into QLB and EOIPB groups. Our primary outcome was the postoperative pain scores measured using the Numerical Rating Scale (NRS) at predetermined intervals. Secondary outcomes included opioid consumption, Riker Sedation–Agitation Scale (RSAS) score, and patient satisfaction. Results: The NRS pain scores at postoperative 30th minute, 4th, 12th, and 24th hours were significantly lower in the QLB group (p < 0.05). Patients in the QLB group required significantly less tramadol compared to the EOIPB group (p < 0.000). The QLB group also demonstrated lower RSAS scores (p = 0.005), indicating a smoother recovery process. Patient satisfaction scores were markedly higher in the QLB group (p < 0.000). Although both blocks were well-tolerated with no differences in side effects, EOIPB was associated with higher opioid consumption, indicating its relatively limited effectiveness. Conclusions: To conclude, this study highlights that QLB is a more effective option for postoperative analgesia and improves patient satisfaction after LC. EOIPB may serve as a viable alternative for some patients; however, given the advantages of QLB in pain control and recovery, it stands out as a more preferable method. Full article

Background: Hip fractures represent a major clinical challenge, particularly in elderly and frail patients, where postoperative pain control must balance effective analgesia with motor preservation to facilitate early mobilization. Various regional anesthesia techniques are used in this setting, including the pericapsular nerve group (PENG) block, fascia iliaca compartment block (FICB), femoral nerve block (FNB), and quadratus lumborum block (QLB), yet optimal strategies remain debated. Objectives: To systematically review the efficacy, safety, and clinical applicability of major regional anesthesia techniques for pain management in hip fractures, including considerations of fracture type, surgical approach, and functional outcomes. Methods: A systematic literature search was conducted following PRISMA 2020 guidelines in PubMed, Scopus, Web of Science, and the virtual library of the Hospital Central de la Defensa “Gómez Ulla” up to March 2025. Inclusion criteria were RCTs, systematic reviews, and meta-analyses evaluating regional anesthesia for hip surgery in adults. Risk of bias in RCTs was assessed using RoB 2.0, and certainty of evidence was evaluated using the GRADE approach. Results: Twenty-nine studies were included, comprising RCTs, systematic reviews, and meta-analyses. PENG block demonstrated superior motor preservation and reduced opioid consumption compared to FICB and FNB, particularly in intracapsular fractures and anterior surgical approaches. FICB and combination strategies (PENG+LFCN or sciatic block) may provide broader analgesic coverage in extracapsular fractures or posterior approaches. The overall risk of bias across RCTs was predominantly low, and certainty of evidence ranged from moderate to high for key outcomes. No significant safety concerns were identified across techniques, although reporting of adverse events was inconsistent. Conclusions: PENG block appears to offer a favorable balance of analgesia and motor preservation in hip fracture surgery, particularly for intracapsular fractures. For extracapsular fractures or posterior approaches, combination strategies may enhance analgesic coverage. Selection of block technique should be tailored to fracture type, surgical approach, and patient-specific functional goals. Full article

Background and Objectives: Regional anesthesia is a key component of multimodal analgesia following minimally invasive gynecologic surgery. However, single-port laparoscopic adnexal surgery differs anatomically and physiologically from multiport or open approaches, particularly in terms of incision site, tissue handling, and pain characteristics. Despite its increasing use, evidence supporting procedure-specific regional analgesic protocols for this approach remains limited. This study aimed to compare the analgesic efficacy of quadratus lumborum block (QLB) and rectus sheath block (RSB) in this surgical context. Materials and Methods: In this randomized controlled trial, 68 patients undergoing single-port laparoscopic adnexal surgery were randomly assigned to receive either QLB or RSB at the end of surgery. Four patients were excluded due to missing patient-controlled analgesia (PCA) data, resulting in 64 patients analyzed (QLB group: n = 32; RSB group: n = 32). The primary outcome was cumulative opioid consumption over the first 24 postoperative hours. Secondary outcomes included interval-based opioid consumption, time to first PCA bolus, postoperative pain scores, and incidence of postoperative nausea and vomiting (PONV). Results: The RSB group demonstrated significantly lower cumulative opioid consumption at 24 h postoperatively (132.9 [61.3, 338.4] µg vs. 453.0 [253.1, 811.0] µg, p < 0.001). This trend persisted across most postoperative time points up to 48 h. Interval-based opioid consumption was also lower in the RSB group during 0–24 h and 32–48 h intervals (each comparison p < 0.05). The time to first PCA bolus was significantly longer in the RSB group (56.5 [41.0, 340.3] minutes vs. 40.5 [33.3, 68.8] minutes; p = 0.014), and Kaplan–Meier analysis confirmed a delayed first bolus request in the RSB group (log-rank p = 0.007). Pain scores and postoperative nausea and vomiting incidence were comparable between groups. Conclusions: Compared with QLB, RSB provided similar pain relief with significantly lower opioid consumption following single-port laparoscopic adnexal surgery. These findings highlight the potential advantages of RSB in enhancing analgesic efficiency and support the development of procedure-specific regional analgesia protocols tailored to this surgical approach. Full article

The evolution of regional anesthesia in total hip arthroplasty (THA) has significantly impacted perioperative management, particularly in older adults, where age-related physiological vulnerability requires optimized strategies. Adequate pain control is crucial in enhancing recovery, minimizing opioid consumption, and reducing complications. Traditional nerve blocks such as lumbar plexus and femoral nerve blocks have long been the mainstay of analgesia. However, they are associated with significant motor impairments, which delay mobilization and increase the fall risks. Introducing motor-sparing regional anesthesia techniques represents a substantial advancement in optimizing postoperative pain management while preserving muscle function. Motor-sparing techniques, including the pericapsular nerve group (PENG) block, supra-inguinal fascia iliaca block (SI-FIB), erector spinae plane block (ESPB), and quadratus lumborum block (QLB), have been developed to provide adequate analgesia without compromising motor control. The PENG block selectively targets the articular branches of the femoral, obturator, and accessory obturator nerves, ensuring superior pain relief while minimizing quadriceps weakness. Similarly, the SI-FIB provides extensive sensory blockade with minimal motor involvement, allowing for earlier ambulation. The ESPB and QLB extend analgesia beyond the hip region while preserving motor function, reducing opioid consumption, and facilitating early rehabilitation. Compared to traditional motor-impairing blocks, these newer techniques align with Enhanced Recovery After Surgery (ERAS) protocols by promoting early mobility and reducing the hospital length of stay. Studies suggest that motor-sparing blocks lead to improved functional recovery, lower postoperative pain scores, and decreased opioid requirements, which are critical factors in geriatric THA patients. Moreover, these techniques present a safer alternative, reducing the risk of postoperative falls—a significant concern in elderly patients undergoing hip replacement. Despite their advantages, motor-sparing nerve blocks are still evolving, and further research is necessary to standardize the protocols, optimize the dosing strategies, and evaluate the long-term functional benefits. Integrating these techniques into routine perioperative care may significantly enhance patient outcomes and revolutionize pain management in geriatric THA. As regional anesthesia advances, motor-sparing techniques will improve postoperative recovery, ensuring patient safety and functional independence. Full article

Background and Objectives: Extensive research has demonstrated that various approaches to the quadratus lumborum (QL) block offer superior postoperative analgesia compared to the transversus abdominis plane (TAP) block, particularly in reducing opioid consumption. This study aims to compare postoperative analgesia between the blocks in laparoscopic colorectal surgery. Materials and Methods: A retrospective analysis was performed on patients with elective colorectal surgeries who received bilateral US TAP blocks in the supine position or US anterior QL block in the lateral position at the end of the surgery and before extubating, with Ropivacaine 0.25%. Total opioid consumption and time to first intravenous analgesic were noted. Results: Between January 2020 and December 2024, 410 patients underwent elective laparoscopic colorectal oncology surgery under general anesthesia, with peripheral nerve blocks. Of these, we analyzed 116 patients with localized diseases who underwent elective surgeries and who did not require conversion to classical surgery and received either QL or TAP blocks. A total of 62 patients underwent QL block and 54 received TAP block. For the primary outcome, in the QL group, significantly fewer opioids were used than in the TAP group (p < 0.001), and time to first rescue analgesic was prolonged in the QL group at 16 h (IQR 14–18) compared to the TAP group, where the requirement occurred earlier at 8 h (IQR 8–8) postoperatively (p < 0.001). Conclusions: Postoperative bilateral US anterior QL block reduced morphine consumption and improved time to rescue analgesia and LOS compared with midaxillary line bilateral US TAP block. Full article

Background and Objectives: Quadratus lumborum block (QLB) is a regional anesthesia technique widely utilized in multimodal analgesia strategies for abdominal surgeries. While a few studies have investigated its efficacy in multiport total laparoscopic hysterectomy (TLH), its effectiveness in single-port TLH remains uncertain. This study aimed to evaluate whether QLB reduces opioid consumption and postoperative pain in patients undergoing single-port TLH. Materials and Methods: This randomized, controlled, observer-blinded trial included 64 patients undergoing elective single-port TLH. Participants were randomly allocated to either the QLB group (n = 27) or the control group (n = 29). QLB was performed bilaterally under ultrasound guidance after surgery. The primary outcome was cumulative fentanyl consumption within 24 h postoperatively. Secondary outcomes included pain scores at predefined intervals, time to first opioid demand, the incidence of postoperative nausea and vomiting (PONV), and other complications. Results: The 24 h cumulative fentanyl consumption, which was the primary outcome, did not differ significantly between the QLB group, 342.8 [220, 651] mcg, and the control group, 470 [191.6, 648.1] mcg (p = 0.714). Similarly, cumulative fentanyl consumption at other time points, including 2 h, 4 h, 8 h, 12 h, 32 h, and 48 h, as well as in the PACU, also showed no significant differences between the two groups. Pain scores measured at these time points, along with the time to first bolus on demand, were comparable between groups. However, PONV occurred more frequently in the QLB group than in the control group (25.9% vs. 3.4%, p = 0.023). Conclusions: QLB did not significantly reduce opioid consumption, time to first opioid demand, or postoperative pain scores in single-port TLH. However, PONV occurred more frequently in the QLB group. These findings suggest that QLB may have limited analgesic benefits in single-port TLH. Full article

Objective: Investigate the effect of bilateral ultrasound-guided quadratus lumborum block (QLB) in the need for additional opioid administration in response to intraoperative nociception during ovariectomy in cats. Methods: Thirty-six feral cats were randomly allocated to group control (C) or group QLB with 0.4 mL kg⁻¹ of 0.25% bupivacaine per hemiabdomen. Hemodynamic data were collected at five intraoperative time points. A 20% increase in pulse rate or respiratory rate was treated with fentanyl. Results: Pulse rate and respiratory rate were higher in the C group compared to the QLB group during ovarian manipulation. No differences in systolic and mean arterial pressure and hypotension were comparable in both groups. The QLB group required less administration of intraoperative fentanyl than the C group at 4/16 and 10/16, respectively (p < 0.05). Conclusions: The bilateral QLB with bupivacaine led to a reduction in opioid consumption in feral cats undergoing elective ovariectomy. Full article

This study aimed to describe an ultrasound-guided technique for implanting catheters for local anesthetic administration into the quadratus lumborum (QL) inter-fascial plane in canine cadavers and assessing the spread along the vertebral bodies (VBs) by computed tomography (CT). Phase 1: eight canine cadavers received one catheter per hemiabdomen, followed by injection of contrast media solution [low volume (L_V) 0.3 mL kg⁻¹ or high volume (H_V) 0.6 mL kg⁻¹]. Phase 2: postoperative pain of five dogs was managed by injecting 0.3 mL kg⁻¹ of ropivacaine 0.5% through QL catheters every eight hours, up to 72 h after abdominal surgery. Pain was assessed using the Short Form of the Glasgow Composite Measure Pain Scale, and methadone 0.2 mg kg⁻¹ was administered intravenously when the pain score was ≥6. The number of VBs stained by the contrast solution between the QL and psoas minor muscles was significantly higher in group H_V than group L_V. The catheter tip was visualized in the retroperitoneal space in 1/16 and 2/10 hemiabdomens in phases 1 and 2, respectively. Rescue analgesia was required in 3/5 dogs during the postoperative period. The QL catheter placement technique appears feasible and may be included in a multimodal analgesic approach for dogs undergoing abdominal surgeries. Full article

In veterinary medicine, the use of loco-regional anesthesia techniques is increasing. The Quadratus Lumborum block (QL) is an interfascial loco-regional technique that involves the release of local anesthetic (LA) between the Quadratus Lumborum and the Small Psoas (Pm) muscle. The study aims to evaluate the effect of the QL block on reducing the total amount of opioids in dogs undergoing pre-scrotal orchiectomy. A group of 36 dogs was enrolled in a randomized blinded study. The animals were divided into two groups: 18 in the experimental group (QL) and 18 in the control group (C). The QL group received 0.4 mL kg⁻¹ of ropivacaine 0.5% for each hemiabdomen (total amount of 3 mg kg⁻¹ of ropivacaine, 1.5 mg kg⁻¹ per side). The C group was brought into the operating room (OR) after receiving the same clipping as the QL group. In the intraoperative period, opioid consumption in the QL group was significantly lower than in the C group. No differences were found in the post-operative phase. No side effects were reported when performing the QL technique. The QL block performed at the level of L6 appears to be a valid approach to reducing opioid use in dogs undergoing orchidectomy with a pre-scrotal surgical approach. Full article

This study assessed the analgesic and motor effects of the GIN-TONIC block, a combination of the greater ischiatic notch plane block and the caudal lateral quadratus lumborum block, in 24 dogs undergoing pelvic limb surgery. Dogs were randomly divided into two equal groups: G_A received acepromazine [(20 µg kg⁻¹ intravenously (IV)] as premedication, and G_D received dexmedetomidine (2 µg kg⁻¹ IV). General anesthesia was maintained with isoflurane, and both groups received a GIN-TONIC block using 2% lidocaine. Nociception during surgery and postoperative pain [assessed using the Glasgow Composite Measure Pain Score (GCMPS-SF)] were assessed. Fentanyl (2 µg kg⁻¹ IV) was administered if nociception was noted and morphine (0.5 mg kg⁻¹ IV) was administered during recovery if the pain scores exceeded the predefined threshold. Motor function was assessed during the recovery period using descriptors previously reported. All dogs received analgesics at the 4 h mark before being discharged. Three and two dogs in G_D and G_A required fentanyl once. Postoperative pain scores remained ≤4/20 for all dogs except one. Dogs achieved non-ataxic ambulation within 38.9 ± 10.3 and 35.1 ± 11.1 min after extubation in G_D and G_A, respectively. This study highlighted the potential of the GIN-TONIC block as a feasible regional anesthesia method for delivering perioperative analgesia in dogs undergoing pelvic limb orthopedic surgery. Full article

Background: Ultrasound-guided quadratus lumborum block (QLB) and sacrococcygeal epidural anaesthesia (ScE) have been used for neutering cats, providing effective pain relief. Objectives: To compare the effects of the QLB with those of ScE in cats undergoing ovariectomies. Methods: Feral cats undergoing ovariectomy were premedicated with dexmedetomidine (20 μg kg⁻¹) and methadone (0.2 mg kg⁻¹) intramuscularly. Anaesthesia was induced with 2–4 mg kg⁻¹ of propofol intravenously and maintained with isoflurane in oxygen. The cats were randomly allocated to the groups QLB (bilateral QLB with 0.4 mL kg⁻¹ of 0.25% bupivacaine) and ScE (0.3 mL kg⁻¹ of 0.25% bupivacaine). Hemodynamic data and analgesia rescue were collected at four intraoperative periods. The pain scale and motor block were assessed in both groups during the postoperative period. Results: The ScE results in increased hypotension, prolonged extubation time, and higher postoperative motor block than the QLB (p < 0.05). The QLB and ScE groups required a similar number of intraoperative rescues and presented the same postoperative pain scale classification. Conclusions: The QLB with 0.25% bupivacaine is a potential alternative to ScE with 0.25% bupivacaine in perioperative pain management in elective cat ovariectomy. The QLB promoted less hypotension and postoperative motor block when compared with the ScE group. Full article