Bilateral quadratus lumborum block versus epidural morphine in aortobifemoral bypass graft surgery under general anaesthesia: A prospective randomized controlled study

Abstract

ABSTRACTBackground: Anaesthesia for patients with peripheral vascular disorders carries special challenges for the anaesthetist. The current study assessed the efficacy of pain management with bilateral quadratus lumborum block versus epidural morphine in patients undergoing aortobifemoral bypass under general anaesthesia.Settings and Design: Prospective randomized controlled trial.Methods: This work enrolled 30 patients undergoing aortobifemoral bypass under general anaesthesia. Patients were randomized into two groups. Group A received bilateral quadratus lumborum block using 20 ml 0.25% bupivacaine on each side and group B were given 4 mg morphine in 20 ml saline solution in an epidural catheter before induction of anaesthesia. Vital signs were recorded. Both rest and movement visual analogue scale (VASR and VASM respectively) were recorded postoperatively at 3, 6, 12, 18 and 24 hours. Postoperative total dose of rescue analgesic Nalbuphine and timing of first analgesic request were recorded. NO and IL-6 were assessed preoperatively and 6 hours postoperatively. Patient satisfaction was recorded at the end of study.Results: No significant difference in pain intensity through the initial six postoperative hours. VASR was significantly lesser in group A at 6th, 12th and 18th hours postoperatively (p = 0.015, <0.001 and <0.001 respectively), and 6th, 12th, 18th and 24th postoperative hours with VASM (p = 0.029, <0.001, 0.015 and 0.010 respectively). In group A the total dose of rescue analgesic was significantly less (p = 0.015) and time of first analgesic request was significantly earlier in group B (p = 0.042). NO and IL-6 levels were significantly lesser in group A at 6 hours postoperative (p = 0.014 and 0.021 respectively). Patient satisfaction was statistically better in group A (p = 0.028).Conclusion: Bilateral quadratus lumborum block may be more beneficial than epidural morphine for postoperative analgesia in patients undergoing aortobifemoral bypass surgery.