Date of this Version
Background: Poor post-operative pain control is associated with patient dissatisfaction, contributes to a delayed recovery, and increases the incidence of post-operative morbidity. The conventional transversus abdominis plane block (TAPB) results in exerting analgesic effects on the muscle, skin, and parietal peritoneum of the anterior abdominal wall, providing somatic analgesia with little to no visceral blockade. The need for visceral blockade to provide optimal postoperative pain relief has led to a more posterior approach that involves injecting the anesthetic adjacent to the quadratus lumborum muscle. The quadratus lumborum block (QLB) results in the spread of local anesthetic solution along the endothoracic and thoracolumbar fascia into the paravertebral space. This space, surrounded by adipose tissue, results in delayed local anesthetic uptake into systemic circulation, leading to prolonged analgesia. Evidence suggests efficacy of the TAPB may be more limited, and that QLB implementation should be considered to provide optimal outcomes for all patients undergoing abdominal surgery.
Objectives: (1) To determine the more effective regional anesthesia technique as it relates to superior post-operative analgesia for patients undergoing abdominal surgery utilizing four databases: Cochrane, MedLine, CINAHL, and PubMed. This systematic review will serve as the basis for objective two. (2) To demonstrate an increase in knowledge in anesthesia providers pertaining to the utilization of the QLB for post-operative analgesia following abdominal surgery.
Methodology: Seven randomized controlled trials (RCTs) were evaluated in this systematic review containing a total of 469 surgical patients. The RCTs found that the QLB provided longer and more effective postoperative analgesia. A majority of the studies also found that patients who received the QLB required fewer opioid analgesics postoperatively, and had lower overall pain scores as compared to the patients who received the TAPB. With this information, a pre-test, educational module, and post-test were created for anesthesia providers to evaluate both baseline knowledge and knowledge growth.
Results: The statistical analysis between the pre-test and post-test showed an increase in provider knowledge. There was also an increase in the providers’ likelihood to utilize the QLB for patients undergoing abdominal surgery.
Conclusions: The QLB provides superior pain management with a longer duration of post-operative analgesia, reduced total opioid consumption, and is associated with better overall pain scores than the TAPB after abdominal surgery. Continual implementation of this quality improvement project has the potential to improve the outcomes of surgical patients, ensure more optimal post-operative pain management, and decrease opioid use in patients undergoing abdominal surgery. Overall, the intervention was effective in increasing anesthesia providers’ knowledge and confidence regarding the utilization of the QLB as an alternative to the TAPB.
Agostino, Danielle MSN, RN and Gonzalez, Vicente DNP, CRNA, APRN, "Education Intervention Regarding Utilization of the Quadratus Lumborum Block for Post-Operative Analgesia Following Abdominal Surgery" (2021). Nicole Wertheim College of Nursing Student Projects. 92.