P.132 Quadratus lumborum for fast track liver transplantation. Does it work? Is it safe?
Saturday May 04, 2019 from 18:30 to 20:00
Exhibit-Poster Area
Presenter

Daniela Damian, United States

Clinical Assistant Professor

Aneshesiology

Children's Hospital of Pittsburgh

Abstract

Quadratus lumborum for fast track liver transplantation. Does it work? Is it safe?

Mihaela Visoiu1, Michael Kolan1, George V. Mazariegos2, Daniela Damian1.

1Anesthesiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, United States; 2Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, United States

Introduction: Significant pain and delayed extubation are common after liver transplantation. Ultrasound guided quadratus lumborum blocks can facilitate extubation in the operating room and decrese opioid consumption. 

Method: We performed a retrospective chart review (2015-2017) and identified 7 patients who underwent liver transplantation and received an ultrasound guided, bilateral, quadratus lumborum (QL) single injection nerve blocks. The QL were done after induction of general anesthesia, using ropivacaine (0.2% to 1%) and additional opioids were used during the transplant (remifentanil vs sufentany and fentanyl). After extubation the patients received a patient controlled analgesia with hydromorphone. Postoperative pain scores and consumtion of analgesics were recorded for 24 hours after conclusion of the surgey. The coagualtion profile was recorded for the first 24 hours.

Results: Demographic data and surgical characteristics are presented in Table 1.

The volume of ropivacaine administered was 0.3 ml/kg/block (SD +/- 0.09). The mean total amount of ropivacaine administered to each patient was 3.2 mg/kg (SD +/- 0.7). The mean reperfusion time was 273.4 minutes (SD +/- 34.7) after the blocks were performed. Six patients received heparin at a mean interval of 265.3 minutes (SD +/- 64.1) after the blocks were performed.  Six patients were extubated immediately after surgery in the operating room. One patient remained intubated secondary to prolonged hemodynamic instability after reperfusion related to the surgical graft. This patient was excluded from the pain score and hydromorphone consumption calculations. The mean pain score over the first 24 hours was 1 (SD +/- 1.6) and the mean hydromorphone consumption over the first 24 hours was 8.7 mcg/kg/hr (SD +/- 2.9). No patient need it to be reintubated. Intraoperative and postoperative coagulation profiles are presented in Table 2.

 

There was no bleeding or bruising at the QL site. 

Conclusion: With proper patient selection, quadratus lumborum blocks can be effective for intraoperative and postoperative pain control, and can facilitate early extubation. The practice of fast track anesthesia may decrease the incidence of pulmonary complications and improve graft function. The blocks should be done preoperatively to avoid retroperitoneal hematoma formation after reperfusion and heparin administration. More cases are needed to confirm the efficacy and safety of QLB for this patient population.

References:

[1] Aniskevich S, et al. Fast track anesthesia for liver transplantation: Review of the current practice World J Hepatol. 2015; 7(20): 2303–2308


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