Dexmedetomidine Added to Bupivacaine versus Bupivacaine in Transincisional Ultrasound-Guided Quadratus Lumborum Block in Open Renal Surgeries: A Randomized Trial

Background: General anesthesia (GA) is the preferred anesthetic modality for open renal surgeries to ensure a patent airway while the patient is in the lateral decubitus position. However, these surgeries are usually accompanied by severe postoperative pain with increased requirements for multimodal pain management strategies. Regional blocks provide better postoperative pain control with less systemic opioid consumption. Objectives: The aim of this study was to describe the ultrasound (US)-guided transincisional quadratus lumborum block (TiQLB) as a new approach, and to compare the addition of dexmedetomidine to bupivacaine versus bupivacaine alone for TiQLB in combination with GA regarding postoperative analgesia and adverse effects in open renal surgery. Study Design: A prospective, randomized, double-blind, controlled trial. Setting: Ain Shams University Hospitals. Methods: Eighty patients who were scheduled for an elective open renal surgery, aged 20 to 65 years, of either gender, and American Society of Anesthesiologists physical status I to II were enrolled in the study. They were randomly allocated into 2 equal groups: group dexmedetomidine-bupivacaine (DB) (n = 40) in which patients received combined GA plus TiQLB with 30 mL bupivacaine 0.25% plus 1 μg/kg dexmedetomidine, and group bupivacaine (B) (n = 40) in which patients received combined GA plus TiQLB with 30 mL bupivacaine 0.25% only. The primary outcome was the total morphine consumption among both groups, whereas the secondary outcomes were the Visual Analog Scale (VAS) scores and the time to first analgesic requirement during the first 24 hours. Postoperative side effects, such as sedation, nausea, vomiting, shivering, pruritus, bradycardia, hypotension, and respiratory depression, were also recorded. Results: Patients in the DB group experienced lower total morphine consumption and lower VAS scores when compared with patients in the B group (P < 0.001). Time to first analgesic requirement was prolonged in patients in the DB group (18.6 ± 2.4 hours) in comparison to patients in the B group (7.3 ± 1.1 hours). Ten minutes after the block there was a significant reduction in mean blood pressure and heart rate in the DB group than in the B group. Regarding postoperative adverse effects, sedation scores were higher in the DB group than in the B group, postoperative nausea, vomiting, and shivering were significantly higher in the B group than in the DB group. Bradycardia was significantly more frequent among the DB group. Although nonsignificant, pruritus was more frequent in the B group than in the DB group. No cases of respiratory depression were reported in both groups. Limitations: The used technique US-guided TiQLB could be performed in open renal surgeries only. Conclusions: The new approach US-guided TiQLB was effective and easy to be performed. Adding dexmedetomidine to bupivacaine in TiQLB was associated with potent and prolonged postoperative analgesia with fewer postoperative adverse effects. Key words: Quadratus lumborum block, dexmedetomidine, open renal surgery, postoperative pain, bupivacaine

Percutaneous Nephrolithotomy With One Shot Dilatıon Method: Is It Safe In Patients Who Had Open Surgery Before

<p><strong>ABSTRACT</strong></p><p> <strong>Purpose: </strong>This study is aimed to evaluate whether one shot dilatation technique is safe in patients with a history of open stone surgery, as it is in patients without previous open stone surgery.</p><p><strong>Materials And Methods: </strong>Between January 2007-February 2015, 82 patients who underwent PNL surgery with one shot dilation technique and having previously had open stone surgery were retrospectively reviewed and evaluated under group 1. Again, 82 patients were selected randomly among patients who had PNL with one shot dilation technique but having no history of open renal surgery and these are denominated as group 2. Age, gender, type of kidney stone , duration of surgery, radiation exposure time and whether there was any bleeding requiring perioperative and postoperative transfusion or not were noted for each patient .</p><p><strong>Results: </strong>The stone-free rates, operation and fluoroscopy time , peroperative and postoperative complication rates were similar in two groups (p&gt;0.05).</p><strong>Conclusion: </strong>Our experience indicated that the PNL with one shot dilation technique is a reliable method in patients with a history of open stone surgery.