Quadratus Lumborum Block versus Thoracic Paravertebral Block for Postoperative Recovery Quality after Percutaneous Nephrolithotomy: A Randomized Noninferiority Trial.

Authors

Wenjun Lin, Qingfu Zhang, Feifei Zheng, Linshan Huang, Weitao Gao, Jinsheng Guan, Guisheng Ding

Published in

Pain and therapy. Aug 18, 2026. Epub Aug 18, 2026.

Abstract

We aimed to determine whether anterior quadratus lumborum block (QLB) at the lateral supra-arcuate ligament is noninferior to thoracic paravertebral block (TPVB) for postoperative recovery quality after percutaneous nephrolithotomy (PCNL).
A total of 72 adults (American Society of Anesthesiologists physical status I-II) undergoing elective unilateral PCNL were randomized to QLB (n = 36) or TPVB (n = 36). Before general anesthesia, patients received ultrasound-guided anterior QLB (0.5% ropivacaine, 30 mL) or TPVB (0.5% ropivacaine, 20 mL), with standardized multimodal analgesia including patient-controlled intravenous morphine. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24 h; noninferiority required the lower bound of the 95% confidence interval (CI) for the difference (QLB minus TPVB) to exceed the prespecified margin of -6 points in both the modified intention-to-treat and per-protocol populations. Secondary outcomes were pain intensity, morphine consumption, patient satisfaction, and adverse events.
Median QoR-15 scores at 24 h were 124 (interquartile range [IQR], 118-128) for QLB and 122 (IQR, 117-125) for TPVB (median difference, 2; 95% CI, -1 to 5; p < 0.001 for noninferiority), robust at stricter margins and confirmed per protocol. In secondary and exploratory analyses, QLB prolonged time to first analgesia (from postanesthesia care unit [PACU] admission; restricted mean survival time difference, 7.9 h; 95% CI, 5.9 to 9.8; time-averaged hazard ratio, 0.18; 95% CI, 0.10 to 0.31; p < 0.001), reduced 24-h morphine consumption (-4 mg; 95% CI, -6 to 0; p = 0.035), and lowered pain area under the curve at rest (-10 cm·h; 95% CI, -15 to -4) and on movement (-15 cm·h; 95% CI, -22 to -8; both p < 0.001). Hypotension occurred in 4 of 35 patients (11%) with QLB versus 13 of 36 (36%) with TPVB (relative risk, 0.32; 95% CI, 0.11 to 0.88; p = 0.015).
Anterior QLB was noninferior to TPVB for postoperative recovery quality after PCNL. Associated reductions in pain and opioid use, and a lower observed incidence of hypotension, seen in secondary and exploratory analyses, are hypothesis-generating and warrant confirmation. Graphical abstract available for this article.
Chinese Clinical Trial Registry, ChiCTR2100044431.

PMID:
42613545
Bibliographic data and abstract were imported from PubMed on 20 Aug 2026.

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