AHMET MURAT YAYIK, Ali AHISKALIOĞLU, Özlem Dilara ERGÜNEY, Elif ORAL AHISKALIOĞLU, Hacı Ahmet ALICI, Saban Oguz DEMIRDOGEN, Şenol ADANUR

Analgesic efficacy of ultrasound-guided quadratus lumborum block during extracorporeal shock wave lithotripsy

Extracorporeal shockwave lithotripsy (ESWL) is widely used for the treatment of urinary tract calculi; however, the vast majority of the patients does not tolerate the procedure without analgesia and sedation. Pain control in ESWL has been crucial for process success and patient comfort. Systemic drugs, such as non-steroid anti-inflammatory drugs, opioids, alfa-2 agonist and various local and regional anesthesia methods (transversus abdominis plane block, paravertebral block, infiltration) have been applied to control ESWL pain. Quadratus lumborum block (QLB) is performed as one of the regional anesthetic techniques for abdominal surgery. This block provides anesthesia and analgesia on the anterior and lateral wall of the abdomen. In this report, we presented the analgesic efficacy of QLB in 15 patients, which included nine renal and six ureter stones for ESWL. The mean of the VAS scores ranged from 0.20±0.41 to 2.73±1.22, and mean fentanyl consumption was 15.00±15.08 mcg during the procedure. No opioid-related side effects were observed in any of the patients. Full fragmentation was obtained in nine of the 15 patients, and partial fragmentation was obtained in five patients.

Ekstrakorporeal şok dalga litotripside ultrasound eşliğinde uygulanan quadratus lumborum bloğunun analjezik etkinliği

Ekstrakorporeal şok dalga litotripsi (ESWL), üriner trakt taş tedavisinde yaygın olarak uygulanmaktadır; ancak hastaların büyük çoğunluğu sedasyon ve analjezi olmaksızın bu işlemi tolere edememektedir. ESWL’de ağrı kontrolü işlem başarısı ve hasta konforu açısından önemlidir. ESWL ağrı kontrolünde, non-steroid antiinflamatuar ilaçlar, opioidler, alfa-2 agonistler gibi sistemik ilaçlar; TAP blok, paravertebral blok ve lokal infiltrasyon gibi çeşitli rejyonel anestezi yöntemleri uygulanmıştır. Quadratus lumborum bloğu (QLB) abdominal cerrahide uygulanan rejyonel analjezik yöntemlerden biridir. Bu blok batın ön ve yan duvarında anestezi ve analjezi sağlar. Bu vaka serisinde, dokuzu renal taş ve altısı üreter taşı olmak üzere QLB eşliğinde ESWL yapılan 15 hasta sunulmuştur. İşlem sırasındaki VAS skorları, ortalama 0.20±0.41 ile 2.73±1.22 arasındaydı, ortalama fentanil tüketimi 15.00±15.08 mcg olup hiçbir hastada opioide bağlı yan etki görülmedi. 15 hastanın dokuzunda tam fragmantasyon, beşinde de parsiyel fragmantasyon elde edildi.

PDF

___

1. Salinas AS, Lorenzo-Romero J, Segura M, Calero MR, Hernández-Millán I, Martínez-Martín M, et al. Factors determining analgesic and sedative drug requirements during extracorporeal shock wave lithotripsy. Urol Int 1999;63(2):92–101.

2. Alhashemi JA, Kaki AM. Dexmedetomidine in combination with morphine PCA provides superior analgesia for shockwave lithotripsy. Can J Anaesth 2004;51(4):342–7.

3. Elnabtity AM, Tawfeek MM, Keera AA, Badran YA. Is unilateral transversus abdominis plane block an analgesic alternative for ureteric shock wave lithotripsy? Anesth Essays Res 2015;9(1):51–6.

4. Hanoura S, Elsayed M, Eldegwy M, Elsayed A, Ewieda T, Shehab M. Paravertebral block is a proper alternative anesthesia for outpatient lithotripsy. Anesth Essays Res 2013;7(3):365–70.

5. Acar A, Erhan E, Nuri Deniz M, Ugur G. The Effect of EMLA Cream on Patient-Controlled Analgesia with Remifentanil in ESWL Procedure: A Placebo-Controlled Randomized Study. Anesth Pain Med 2013;2(3):119–22.

6. Blanco R. 271: Tap block under ultrasound guidance: the description of a “no pops” technique. Regional Anesthesia and Pain Medicine 2007;32(5):130.

7. Visoiu M, Yakovleva N. Continuous postoperative analgesia via quadratus lumborum block - an alternative to transversus abdominis plane block. Paediatr Anaesth 2013;23(10):959–61.

8. Baidya DK, Maitra S, Arora MK, Agarwal A. Quadratus lumborum block: an effective method of perioperative analgesia in children undergoing pyeloplasty. J Clin Anesth 2015;27(8):694–6.

9. Chakraborty A, Goswami J, Patro V. Ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a pediatric patient. A A Case Rep 2015 F;4(3):34–6.

10. Carvalho R, Segura E, Loureiro MD, Assunção JP. Quadratus lumborum block in chronic pain after abdominal hernia repair: case report. Braz J Anesthesiol 2017;67(1):107–9.

11. Blanco R, Ansari T, Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: A randomised controlled trial. Eur J Anaesthesiol 2015;32(11):812–8.

12. Chakraborty A, Khemka R, Datta T. Ultrasound-guided truncal blocks: A new frontier in regional anaesthesia. Indian J Anaesth 2016;60(10):703–11.

13. Gupta NP, Kumar A. Analgesia for pain control during extracorporeal shock wave lithotripsy: Current status. Indian J Urol 2008;24(2):155–8.

14. Lawler AC, Ghiraldi EM, Tong C, Friedlander JI. Extracorporeal Shock Wave Therapy: Current Perspectives and Future Directions. Curr Urol Rep 2017;18(4):25.