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

  • Author: Katrine Tanggaard, Rune Petring Hasselager, Emma Rosenkrantz Hølmich, Christian Hansen, Mette Dam, Troels Dirch Poulsen, Finn Østergård Bærentzen, Jens Ravn Eriksen, Ismail Gögenur and Jens Børglum

  • Published: BMJ 2023


Background and aims: An 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.

Methods: In this randomized, controlled, doubleblinded trial, 69 patients undergoing laparoscopic hemicolectomy due to colon cancer were randomized
to receive an anterior quadratus lumborum block with ropivacaine 0.375% 30mL 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.

Results: The total opioid consumption in the first 24 hours postsurgery was not significantly reduced in the ropivacaine group compared with the saline group (mean 129mg (SD 88.4) vs mean 127.2mg (SD 89.9), p=0.93). In addition, no secondary outcome measures showed any statistically significant intergroup differences

Conclusion: The 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 number NCT03570541.

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