Open Access

ARTICLE

The comparative effectiveness of quadratus lumborum blocks and paravertebral blocks in radical cystectomy patients

Austin J. Lee¹, Jonathan G. Yabes², Nathan Hale³, Ronald L. Hrebinko³, Jeffrey R. Gingrich³, Jodi K. Maranchie³, Mina M. Fam³, Robert M. Turner II³, Benjamin J. Davies³, Bruce Ben-David⁴, Bruce L. Jacobs³

1 School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
2 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
3 Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
4 Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Address correspondence to Dr. Austin J. Lee, 5200 Centre Avenue, Suite 209, Pittsburgh, PA 15232 USA

Canadian Journal of Urology 2018, 25(2), 9255-9261.

Abstract

Introduction: Multimodal analgesia is an effective strategy for managing postoperative pain and reducing opioid dependence. The quadratus lumborum block (QLB) and paravertebral block (PVB) are two regional anesthesia techniques that enhance multimodal pain management. In this study, we aimed to compare the efficacy of these two approaches in patients undergoing radical cystectomy. Materials and methods: A retrospective review was conducted on patients who underwent radical cystectomy between 2014 and 2016. Patients were divided into two groups based on the type of regional anesthesia received: bilateral continuous paravertebral blocks (n = 125) or bilateral single-shot quadratus lumborum blocks (n = 50). The primary outcome was total opioid consumption on postoperative day 0. Secondary outcomes included self-reported pain scores (on a 0–10 scale) and hospital length of stay. Results: There was no significant difference in opioid use on postoperative day 0 between the quadratus lumborum block and paravertebral block groups (29 mg vs. 30 mg, p = 0.90). Similarly, there was no difference in mean pain scores on day 0 (4.0 vs. 3.8, p = 0.72). However, the paravertebral block group had significantly lower pain scores on postoperative days 1 through 3 compared to the quadratus lumborum block group (all p < 0.05). Hospital length of stay did not differ significantly between the two groups (6.6 days vs. 6.2 days, p = 0.41). Conclusion: No differences in early postoperative opioid consumption were observed between patients receiving bilateral continuous paravertebral blocks and those receiving bilateral single-shot quadratus lumborum blocks after radical cystectomy. These findings suggest that the quadratus lumborum block is a viable alternative for incorporating regional anesthesia into a multimodal analgesic regimen following cystectomy.

---

Keywords

---