Translational andrology and urology · 2025
Comparative analgesic efficacy of erector spinae plane block versus quadratus lumborum block in laparoscopic renal cancer surgery: a double-blind randomized trial.
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Zhang Meng, Zhao Shuchuan, Song Siyuan, Zhou Huixian, Li Mingfang, Su Peng, Xu Guangmin
Аннотация
BACKGROUND: Ultrasound-guided erector spinae plane block (ESPB) and quadratus lumborum block (QLB) are increasingly used for perioperative analgesia. However, their comparative efficacy, opioid-sparing effects, and impact on recovery outcomes in patients undergoing laparoscopic renal cancer resection remain unclear. This study aimed to directly compare the analgesic effectiveness and recovery benefits of ESPB versus QLB in this surgical population.
METHODS: In this randomized, double-blind trial, 54 patients scheduled for laparoscopic nephrectomy were allocated to receive either ESPB or QLB with 25 mL of 0.4% ropivacaine under ultrasound guidance. Postoperative analgesia was managed using morphine-based patient-controlled analgesia. The primary outcome was cumulative morphine consumption within 6 hours postoperatively. Secondary outcomes included pain scores, morphine pump activations, the 15-item Quality of Recovery scale (QoR-15) scores, and length of hospital stay.
RESULTS: Patients receiving ESPB had significantly lower morphine consumption during the first 6 hours postoperatively compared to those receiving QLB (4.11±4.05 vs. 6.63±4.61 mg, P<0.05). ESPB was also associated with lower early pain scores, fewer morphine pump activations, higher QoR-15 scores at 24 and 48 hours, and shorter hospitalization (P<0.05 for all). No block-related complications were observed in either group.
CONCLUSIONS: Compared with QLB, ESPB may provide more effective early postoperative analgesia and enhanced recovery in patients undergoing laparoscopic renal cancer surgery. These findings suggest that ESPB may be a valuable option for perioperative pain management in laparoscopic nephrectomy; however, as an exploratory study with limited sample size, further validation in larger populations is necessary.
TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2300074743.
METHODS: In this randomized, double-blind trial, 54 patients scheduled for laparoscopic nephrectomy were allocated to receive either ESPB or QLB with 25 mL of 0.4% ropivacaine under ultrasound guidance. Postoperative analgesia was managed using morphine-based patient-controlled analgesia. The primary outcome was cumulative morphine consumption within 6 hours postoperatively. Secondary outcomes included pain scores, morphine pump activations, the 15-item Quality of Recovery scale (QoR-15) scores, and length of hospital stay.
RESULTS: Patients receiving ESPB had significantly lower morphine consumption during the first 6 hours postoperatively compared to those receiving QLB (4.11±4.05 vs. 6.63±4.61 mg, P<0.05). ESPB was also associated with lower early pain scores, fewer morphine pump activations, higher QoR-15 scores at 24 and 48 hours, and shorter hospitalization (P<0.05 for all). No block-related complications were observed in either group.
CONCLUSIONS: Compared with QLB, ESPB may provide more effective early postoperative analgesia and enhanced recovery in patients undergoing laparoscopic renal cancer surgery. These findings suggest that ESPB may be a valuable option for perioperative pain management in laparoscopic nephrectomy; however, as an exploratory study with limited sample size, further validation in larger populations is necessary.
TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2300074743.