Anterior quadratus lumborum block does not reduce postoperative opioid consumption following laparoscopic hemicolectomy: a randomized, double-blind, controlled trial in an ERAS setting

Abstract

Background and aimsAn opioid-sparing postoperative analgesic regimen following laparoscopic hemicolectomy is optimal to promote minimal postoperative pain, early mobilization, and improved quality of recovery. Various regional anesthesia techniques have been tested to improve postoperative pain management after laparoscopic hemicolectomy. In this study, we aimed to assess the effect of administering a preoperative bilateral ultrasound-guided anterior quadratus lumborum nerve block on postoperative opioid consumption after laparoscopic colon cancer surgery.MethodsIn this randomized, controlled, double-blinded trial, 69 patients undergoing laparoscopic hemicolectomy due to colon cancer were randomized to receive an anterior quadratus lumborum block with ropivacaine 0.375% 30 mL on each side or isotonic saline (placebo). The primary outcome measure was total opioid consumption during the first 24 hours postsurgery. The secondary outcome measures were pain scores, accumulated opioid consumption in 6-hour intervals, nausea and vomiting, ability of postoperative ambulation, time to first opioid, orthostatic hypotension or intolerance, postoperative Quality of Recovery-15 scores, surgical complications, length of hospital stay, and adverse events.ResultsThe total opioid consumption in the first 24 hours postsurgery was not significantly reduced in the ropivacaine group compared with the saline group (mean 129 mg (SD 88.4) vs mean 127.2 mg (SD 89.9), p=0.93). In addition, no secondary outcome measures showed any statistically significant intergroup differences.ConclusionThe administration of a preoperative bilateral anterior quadratus lumborum nerve block as part of a multimodal analgesic regimen for laparoscopic hemicolectomy did not significantly reduce opioid consumption 24 hours postsurgery.Trial registration numberNCT03570541.

The effect of anterior quadratus lumborum block on morphine consumption in minimally invasive colorectal surgery: a multicentre, double‐blind, prospective randomised placebo‐controlled trial

“…Our results are in keeping with other recent publications investigating the anterior quadratus lumborum block in abdominal surgery [15, 16]. In a similar trial by Tanggaard et al., patients consumed a mean (SD) of 129 mg (88.4) oral morphine equivalents in addition to an active anterior quadratus lumborum block vs. 127 (89.9) mg in those allocated to placebo during the first 24 h postoperatively [16]. While the patient characteristics and surgical procedures performed were similar to our population, some elements in their ERAS programme were significantly different from our standard practice.…”

“…In this two-centre double-blind, randomised, placebocontrolled trial there was no significant difference in morphine consumption when an anterior quadratus postoperatively [16]. While the patient characteristics and surgical procedures performed were similar to our population, some elements in their ERAS programme were significantly different from our standard practice.…”

“…Pain generated by laparoscopic colorectal surgery comes from several sites including porthole incisions, distension of the abdominal wall, incisions to remove the partially resected colon and dissection of intestines and other organs. Pain pathways affected by laparoscopic colorectal surgery are extremely complex, involving different segmental areas: the superior mesenteric plexus innervates the ascending colon and a major part of the transverse colon whilst the descending and sigmoid colon, as well as a small part of the transverse colon, are innervated by the inferior mesenteric plexus [16].…”

“…No serious adverse events related to the blocks were observed during our study. Similar to other recent studies [16], in total of 60 ml of 0.375% ropivacaine (equalling a total of 225 mg or approximately 3 mg.kg ‐1 ) was used. This is a high dose but all fascial plane blocks need high volumes to reach their full potential.…”

Postoperative analgesic efficacy of anterior quadratus lumborum block for laparoscopic colorectal surgery: a reply

“…Consequently, administering additional local anaesthetics within 4 h of block placement should be discouraged [5]. In addition, as the majority of fascial plane blocks only cover somatic pain at most, port infiltration is not likely to produce any better pain outcome [6].…”