Effectiveness and safety of ultrasound-guided quadratus lumborum block combined with low-dose spinal anesthesia <i>versus</i> general anesthesia in percutaneous nephrolithotomy: a randomized controlled trial.

Abstract

This study aimed to explore the potential benefits and safety considerations of combining ultrasound-guided quadratus lumborum block (QLB) with low-dose spinal anesthesia (LDSA) versus general anesthesia (GA) for individuals undergoing percutaneous nephrolithotomy (PCNL). This prospective randomized controlled trial included 70 adult patients undergoing PCNL, divided into Group Q (QLB + LDSA, n = 35) and Group G (GA, n = 35). Primary outcomes included postoperative pain, assessed using the Visual Analog Scale (VAS), and opioid consumption, measured by pethidine usage. Secondary outcomes included patient satisfaction, stone clearance rates, hemoglobin and creatinine changes, and adverse events. Multivariate regression analysis identified predictors of outcomes. Postoperative pain scores were significantly lower in Group Q during the first 8 postoperative hours (all p &lt; 0.001). Median pethidine consumption was lower in Group Q (70 mg vs. 105 mg, p &lt; 0.001). Group Q demonstrated superior patient satisfaction, with 82.8% of individuals rating their experience as "satisfied" or "very satisfied," markedly exceeding the 8.6% observed in Group G (p &lt; 0.001). Stone clearance outcomes were comparable between the groups, with no statistically significant difference in residual stone burden (p = 0.348). No significant differences were observed in postoperative hemoglobin levels (Group Q: 11.5 &#xb1; 0.6 g/dL vs. Group G: 11.5 &#xb1; 0.6 g/dL, P = 1.0) or serum creatinine levels (Group Q: 1.0 &#xb1; 0.2 mg/dL vs. Group G: 1.0 &#xb1; 0.2 mg/dL, p = 0.611). In PCNL procedures, QLB in conjunction with LDSA demonstrates superior postoperative analgesia, reduced opioid requirements, and improved patient satisfaction while maintaining comparable perioperative and urological outcomes.