Lomber Diskektomi Cerrahisi Sonrası Postoperatif Analjezi Amacıyla Uygulanan Posterior Yaklaşımlı Quadratus Lumborum Bloğunun Etkisinin Değerlendirilmesi; Retrospektif Gözlemsel Çalışma

Yıl 2022, Cilt: 5 Sayı: 1, 12 - 22, 30.06.2022

Gökhan Sertçakacılar , Güneş Özlem Yıldız

Öz

Lomber disk hernileri intervertebral disk patolojileri içerisinde en sık görülen hastalıklardan birisidir. Lomber diskektomi, bu nedenle beyin cerrahisi girişimlerinin başında gelmektedir. Bu hastaların postoperatif dönemdeki ağrı yönetiminde opioidler sık olarak kullanılmaktadır. Bu ilaçlara ait yan etki insidansından kaçınmak için günümüzde güncel blok teknikleri sıklıkla kullanılır olmuştur. Quadratus lumborum bloğu da (QLB) bu bağlamda gelecek vaad eden bloklardan birisidir. Bu çalışmada, tek seviye lomber diskektomi cerrahisinde ultrason eşliğinde uygulanan QLB’nun postoperatif analjezik etkinliği ve güvenliğinin değerlendirilmesi amaçlanmıştır. Bilateral QLB uygulanan 20 hasta blok grubu olarak ve uygulanmayan 25 hasta ise kontrol grubu olarak çalışmaya dahil edildi. Ameliyat sonrası 1-6-12-24. saatlerde hastaların ağrı skorları ve postoperatif iv opioid tüketimleri değerlendirildi. Ağrı skorları tüm zaman dilimlerinde QLB grubunda anlamlı şekilde düşük saptandı (p0.05). Operasyon sonrası 2. ve 6. saatlerde opioid tüketimi, kontrol grubuna kıyasla blok grubunda anlamlı olarak daha düşük bulundu. (p=0.004 ve p=0.011, sırasıyla) Çalışmamızın sonuçları bilateral quadratus lumborum bloğunun lomber diskektomi operasyonu sonrası analjezi yönetiminde başarılı bir seçenek olarak kullanılabileceğini göstermiştir.

Anahtar Kelimeler

lomber diskektomi, quadratus lumborum bloğu, postoperatif analjezi

Evaluation of the Efficacy of Posterior Approach Quadratus Lumborum Block for Postoperative Analgesia after Lumbar Discectomy Surgery; Retrospective Observational Study

Öz

Lumbar disc hernia is one of the most common diseases among intervertebral disc pathologies. Lumbar discectomy surgery is, therefore, one of the leading neurosurgery interventions. Opioids are frequently used in the postoperative pain management of these patients. However, to avoid side effects of these drugs, current block techniques are frequently used today. Quadratus lumborum block (QLB) is one of the promising blocks in this context. This study aimed to evaluate the postoperative analgesic efficacy and safety of QLB performed under ultrasound guidance in single-level lumbar discectomy surgery. Bilateral QLB applied, 20 patients were included in the study as the block group, and 25 patients who were not applied were included in the study as the control group. Patients were evaluated in pain scores and postoperative intravenous opioid consumption at 2-6-12-24 hours postoperatively. Pain scores were significantly lower in the QLB group in all time periods (p0.05). Opioid consumption at the 2nd and 6th hours after the operation was significantly lower in the block group than in the control group (p= 0.004 and p= 0.011, respectively). The results of our study showed that bilateral QLB can be used as a successful option in the management of analgesia after lumbar discectomy.

Anahtar Kelimeler

lumbar discectomy, quadratus lumborum block, postoperative analgesia

Kaynakça

• Parker, S. L., Mendenhall, S. K., Godil, S. S., Sivasubramanian, P., Cahill, K., Ziewacz, J., & McGirt, M. J. (2015). Incidence of Low Back Pain After Lumbar Discectomy for Herniated Disc and Its Effect on Patient-reported Outcomes. Clinical orthopaedics and related research, 473(6), 1988–1999.
• Kortelainen, P., Puranen, J., Koivisto, E., & Lähde, S. (1985). Symptoms and signs of sciatica and their relation to the localization of the lumbar disc herniation. Spine, 10(1), 88–92.
• McGirt, M. J., Ambrossi, G. L., Datoo, G., Sciubba, D. M., Witham, T. F., Wolinsky, J. P., Gokaslan, Z. L., & Bydon, A. (2009). Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery, 64(2), 338–345.
• Postacchini, F., & Postacchini, R. (2011). Operative management of lumbar disc herniation. Advances in minimally invasive surgery and therapy for spine and nerves, 17-21
• Fjeld, O. R., Grøvle, L., Helgeland, J., Småstuen, M. C., Solberg, T. K., Zwart, J. A., & Grotle, M. (2019). Complications, reoperations, readmissions, and length of hospital stay in 34 639 surgical cases of lumbar disc herniation. The bone & joint journal, 101-B(4), 470–477.
• Krebs, E. E., Lurie, J. D., Fanciullo, G., Tosteson, T. D., Blood, E. A., Carey, T. S., & Weinstein, J. N. (2010). Predictors of long-term opioid use among patients with painful lumbar spine conditions. The journal of pain, 11(1), 44–52.
• Zhao, S. Z., Chung, F., Hanna, D. B., Raymundo, A. L., Cheung, R. Y., & Chen, C. (2004). Dose-response relationship between opioid use and adverse effects after ambulatory surgery. Journal of pain and symptom management, 28(1), 35–46.
• Ueshima, H., Inagaki, M., Toyone, T., & Otake, H. (2019). Efficacy of the Erector Spinae Plane Block for Lumbar Spinal Surgery: A Retrospective Study. Asian spine journal, 13(2), 254–257.
• Blanco, R., Ansari, T., & Girgis, E. (2015). Quadratus lumborum block for postoperative pain after caesarean section: A randomised controlled trial. European journal of anaesthesiology, 32(11), 812–818.
• Ishio, J., Komasawa, N., Kido, H., & Minami, T. (2017). Evaluation of ultrasound-guided posterior quadratus lumborum block for postoperative analgesia after laparoscopic gynecologic surgery. Journal of clinical anesthesia, 41, 1–4.
• Okur, O., Karaduman, D., Tekgul, Z. T., Koroglu, N., & Yildirim, M. (2021). Posterior quadratus lumborum versus transversus abdominis plane block for inguinal hernia repair: a prospective randomized controlled study. Brazilian journal of anesthesiology (Elsevier), 71(5), 505–510.
• Akerman, M., Pejčić, N., & Veličković, I. (2018). A Review of the Quadratus Lumborum Block and ERAS. Frontiers in medicine, 5, 44.
• Gurbet, A., Bekar, A., Bilgin, H., Ozdemir, N., & Kuytu, T. (2014). Preemptive wound infiltration in lumbar laminectomy for postoperative pain: comparison of bupivacaine and levobupivacaine. Turkish neurosurgery, 24(1), 48–53.
• Blanco, R. (2007). 271. Tap block under ultrasound guidance: the description of a “no pops” technique.
• Saadawi, M., Layera, S., Aliste, J., Bravo, D., Leurcharusmee, P., & Tran, Q. (2021). Erector spinae plane block: A narrative review with systematic analysis of the evidence pertaining to clinical indications and alternative truncal blocks. Journal of clinical anesthesia, 68, 110063.
• Kadam V. R. (2013). Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. Journal of anaesthesiology, clinical pharmacology, 29(4), 550–552.
• Murouchi, T., Iwasaki, S., & Yamakage, M. (2016). Quadratus Lumborum Block: Analgesic Effects and Chronological Ropivacaine Concentrations After Laparoscopic Surgery. Regional anesthesia and pain medicine, 41(2), 146–150.
• Ueshima, H., Otake, H., & Lin, J. A. (2017). Ultrasound-Guided Quadratus Lumborum Block: An Updated Review of Anatomy and Techniques. BioMed research international, 2017, 2752876.
• Elsharkawy, H., El-Boghdadly, K., Kolli, S., Esa, W., DeGrande, S., Soliman, L. M., & Drake, R. L. (2017). Injectate spread following anterior sub-costal and posterior approaches to the quadratus lumborum block: A comparative cadaveric study. European journal of anaesthesiology, 34(9), 587–595.
• Kumar, A., Sadeghi, N., Wahal, C., Gadsden, J., & Grant, S. A. (2017). Quadratus Lumborum Spares Paravertebral Space in Fresh Cadaver Injection. Anesthesia and analgesia, 125(2), 708–709.
• Carline, L., McLeod, G. A., & Lamb, C. (2016). A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks. British journal of anaesthesia, 117(3), 387–394.
• Hansen, C. K., Dam, M., Steingrimsdottir, G. E., Laier, G. H., Lebech, M., Poulsen, T. D., Chan, V., Wolmarans, M., Bendtsen, T. F., & Børglum, J. (2019). Ultrasound-guided transmuscular quadratus lumborum block for elective cesarean section significantly reduces postoperative opioid consumption and prolongs time to first opioid request: a double-blind randomized trial. Regional anesthesia and pain medicine, rapm-2019-100540. Advance online publication.
• Ökmen, K., Metin Ökmen, B., & Topal, S. (2018). Ultrasound-guided posterior quadratus lumborum block for postoperative pain after laparoscopic cholecystectomy: A randomized controlled double blind study. Journal of clinical anesthesia, 49, 112–117.
• Bramlett, K., Onel, E., Viscusi, E. R., & Jones, K. (2012). A randomized, double-blind, dose-ranging study comparing wound infiltration of DepoFoam bupivacaine, an extended-release liposomal bupivacaine, to bupivacaine HCl for postsurgical analgesia in total knee arthroplasty. The knee, 19(5), 530–536.