IMPACT OF QUADRATUS LUMBORUM BLOCK AND EPIDURAL ANALGESIA ON FUNCTIONAL RECOVERY OF THE LIVER AFTER SURGICAL RESECTION FOR COLORECTAL LIVER METASTASES
DOI:
https://doi.org/10.15407/exp-oncology.2025.04.478Keywords:
quadratus lumborum block, epidural analgesia, liver resection, colorectal liver metastases, thromboelastography, liver function, lactate, postoperative analgesia, coagulation, ERASAbstract
The aim of the study was to evaluate the impact of quadratus lumborum block (QL block) compared to epidural analgesia (EA) on the postoperative liver functional recovery, coagulation profile, metabolic changes, and hemodynamic stability in patients undergoing liver resection for colorectal liver metastases. Materials and Methods. This prospective randomized study included 64 patients allocated in a 1:1 ratio to EA or QL block groups. 56 patients (28 per group) were included in the final analysis. The primary endpoints were the postoperative alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate levels. Secondary endpoints included protein-synthetic markers, coagulation parameters (fibrinogen, prothrombin index), and thromboelastography (TEG) variables. Results. Both analgesic techniques provided comparable postoperative hepatic and coagulation profiles. The QL block group demonstrated a significant but clinically minimal elevation in ALT/AST on postoperative day 1. The lactate dynamics was similar between the groups without significant differences. Protein-synthetic (albumin, total protein) and coagulation markers showed no significant intergroup differences. TEG revealed transient postoperative alterations characteristic of liver resection; LMM identified consistently higher G values and platelet counts in the QL block group, although these differences lacked clinical significance. No analgesia-related complications were observed. Conclusions. The QL block is a safe and effective alternative to epidural analgesia following liver resection, providing a comparable profile of hepatic function, coagulation status, and hemodynamic stability. Minor statistical differences in selected parameters did not translate into clinical relevance. The QL block may be a rational option for patients with contraindications to EA or increased risk of hemodynamic instability.
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