Postoperative analgesia in kidney transplant laparotomy: Quadratus lumborum block as an alternative

Objective: Effective postoperative pain management promotes better recovery. Continuous epidural (CE) is the standard postoperative analgesia for kidney transplantation; however, patients still report pain and unfavorable side effects. This present study compares the effectiveness of quadratus lumborum block (QLB) versus CE for managing pain and reducing morphine requirements following kidney transplantation. Methods: This randomized-controlled study compared 37 kidney transplant patients: a QLB group (N=19) who received 20 ml 0.375% ropivacaine injection bilaterally and a CE group (N=18) who received 0.2% ropivacaine epidurally by infusion at 6 ml/h. Participants were assessed at 2, 6, 12, and 24h postoperatively for morphine requirements and with a visual analogue scale (VAS) for pain while resting and moving. Results: The VAS scores when resting and moving were similar for both QLB and CE at all-time points (p>0.05 for both treatments). Postoperative morphine requirements also did not differ (p>0.05) between the two groups at any time point. Both groups had similar first-time morphine requirements (802.63 min for QLB vs 871.39 min for CE, p=0.814). Both groups achieved 100% blockade at the level of T10-L1 and had comparable Bromage and Ramsay scores. Conclusion: QLB appears to be a viable alternative approach to CE for pain management after kidney transplantation.