Ultrasound-Guided Transmuscular and Thoracic Paravertebral Block Effective for Acute Postoperative Pain Management in Open Renal Surgeries

Background: Systemic analgesics should be used carefully when treating patients following renal surgery since these patients often have compromised renal function. Therefore, in such individuals, the localized nerve block may be a useful choice. This study's objective was to assess the effectiveness of transmuscular and anterior subcostal QLBs as a secure substitute for thoracic paravertebral blocks guided by ultrasonography for treating immediate postoperative pain in patients having open kidney operations. Methods: This prospective randomized double blinded study was carried out on 54 adult patients who underwent elective open renal surgeries. Patients were randomly classified into three equal groups, all were guided by ultrasonography: Group I: Transmuscular QLB, group II: Anterior Subcostal Quadratus Lumborum (ASQL) Block, and group III: Thoracic Paravertebral (TPV) Block. Results: Regarding the beginning of sensory block, overall intraoperative fentanyl usage, period to first rescue analgesic demand, and overall morphine consumption, there was a substantially significant difference between the three groups (P-value <0.001). VAS revealed a substantial difference between the three groups (P<0.001) at T0 before discharging from PACU, 2, 4 and 6 hours. There was statistically significant increase in patients’ satisfaction in group II&III compared to group I where (P =0.03). Conclusions: Ultrasound-guided anterior subcostal QLB produced safe and adequate analgesia during and after open renal surgeries that was comparable to thoracic paravertebral block, but the transmuscular QLB failed to provide adequate analgesia compared to anterior subcostal QLB and thoracic paravertebral block.