• Huili Li, Danxu Ma, Rong Shi, Peiqi Shao, Yun Wang, and Xiaoping Jin.
• Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
• J Anesth. 2025 Jan 19.

PurposeTo examine the ramifications of both the modified and traditional subcostal anterior quadratus lumborum block (SQLB) on postoperative analgesia in individuals undergoing laparoscopic nephrectomy.MethodsForty-six individuals slated for elective laparoscopic nephrectomy under general anesthesia were randomly assigned to acquire either traditional or modified SQLB using 20 mL of 0.5% ropivacaine. The primary outcome was intravenous morphine-equivalent intake during the first 24 h following surgery. Secondary outcomes included sensory block dermatomes, numerical rating scale (NRS) scores, the total number of patient-controlled analgesia (PCA) demands, rescue analgesic use, and complications related to opioids and nerve block.ResultsThe modified SQLB group had significantly lower morphine-equivalent consumption compared to the traditional SQLB group within the initial 24 h after surgery (23.1 ± 4.3 vs. 34.7 ± 6.8 mg, P < 0.001). The modified SQLB also resulted in a greater number of dermatome segments of sensory block at 5, 10, and 15 min after block (P < 0.05), lower NRS pain scores at rest and during coughing at 6, 24, and 48 h (P < 0.001), and reduced usage of rescue analgesics as well as total PCA demands (P < 0.05). No significant differences were observed in the incidence of complications related to opioids or the nerve block procedure between the two groups.ConclusionsUltrasound-guided modified SQLB confers significantly superior analgesic advantages over the traditional SQLB for patients undergoing laparoscopic nephrectomy, culminating in a marked reduction in postoperative opioid consumption and more efficacious pain management.© 2025. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.

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