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Effects of quadratus lumborum block regional anesthesia on postoperative pain after colorectal resection: a randomized controlled trial

  • Mélissa BoulianneEmail author
  • Pamela Paquet
  • Raymond Veilleux
  • Sébastien Drolet
  • Alexandre Meunier
  • Jonathan Frigault
  • David Simonyan
  • Alexis F. Turgeon
2019 SAGES Oral
  • 77 Downloads

Abstract

Introduction

Postoperative pain following colorectal surgery is associated with a significant use of opioids. Recently, regional anesthesia, such as the posterior quadratus lumborum block (QL2), has been proposed to improve pain relief and reduce opioid use. However, the benefit of the QL2 on postoperative pain control remains controversial.

Methods

We conducted a randomized controlled trial of patients undergoing colorectal surgery at the CHU de Québec-Université Laval. Patients were randomized to regional QL2 anesthesia with 150 mg of ropivacaine combined with standard analgesia or to QL2 with a sham intervention and standard analgesia. Our primary outcome was postoperative opioid administration at 24 h. Secondary outcomes included opioid administration in the post-anesthesia care unit (PACU), at 48 h and at hospital discharge, postoperative pain scores, delay in resumption of intestinal transit, nausea and vomiting, and hospital length of stay.

Results

A total of 62 patients were enrolled from November 2017 to February 2018. QL2 regional anesthesia compared with a sham intervention was not associated with a reduction in postoperative morphine dose equivalent (100.2 mg, 95% CI 68.9–131.5 versus 88.7 mg, 95% CI 59.3–118.0, p = 0.81, respectively). Compared to QL2 regional anesthesia, postoperative pain scores in the control group were lower although statistical significance was not consistent for all postoperative time points. Other secondary outcomes were comparable between both groups.

Conclusion

We did not observe a reduction in postoperative opioid administration at 24 h with a posterior quadratus lumborum block regional anesthesia in patients undergoing elective colorectal surgery.

Graphic abstract

Keywords

Colorectal surgery ERAS QL2 Quadratus lumborum block Regional anesthesia 

Notes

Acknowledgements

We wish to acknowledge the contribution of Dr Marie-Claude Paquet and Dr Billy Levasseur to this project with their help in performing the quadratus lumborum blocks. We also want to thank Mrs Rosemarie Ouellet-Larochelle, graphic designer, for designing the visual abstract.

Funding

There was no outside funding for this trial.

Compliance with ethical standards

Disclosures

M. Boulianne, P. Paquet, R. Veilleux, S. Drolet, A. Meunier, J. Frigault, D. Simonyan, and AF. Turgeon have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Akerman M, Pejcic N, Velickovic I (2018) A review of the quadratus lumborum block and ERAS. Front Med (Lausanne) 5:44CrossRefGoogle Scholar
  2. 2.
    Kehlet H (1989) The stress response to surgery: release mechanisms and the modifying effect of pain relief. Acta Chirurgica Scand 550:22Google Scholar
  3. 3.
    Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. The Lancet 362(9399):1921–1928CrossRefGoogle Scholar
  4. 4.
    Barletta JF, Asgeirsson AJ, Fau-Senagore T, Senagore AJ (2011) Influence of intravenous opioid dose on postoperative ileu. Ann Pharmacother 45:916–923PubMedCrossRefGoogle Scholar
  5. 5.
    Nimmo SM, Foo ITH, Paterson HM (2017) Enhanced recovery after surgery: pain management. J Surg Oncol 116(5):583–591PubMedCrossRefGoogle Scholar
  6. 6.
    Borzellino GA-O et al (2016) Role of epidural analgesia within an ERAS program after laparoscopic colorectal surgery: a review and meta-analysis of randomised controlled studies. Surg Res Pract.  https://doi.org/10.1155/2016/7543684 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Grass F et al (2017) Postoperative urinary retention in colorectal surgery within an enhanced recovery pathway. J Surg Res 207:70–76PubMedCrossRefGoogle Scholar
  8. 8.
    Modasi AA et al (2019) NSAID administration post colorectal surgery increases anastomotic leak rate: systematic review/meta-analysis. Surg. Endosc 33(3):879–885PubMedCrossRefGoogle Scholar
  9. 9.
    Rafi AN (2001) Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 56(10):1024–1026PubMedCrossRefGoogle Scholar
  10. 10.
    Chin KJ et al (2017) Essentials of our current understanding: abdominal wall blocks. Req Anesth Pain Med 42(2):133–183CrossRefGoogle Scholar
  11. 11.
    McDonnell JG et al (2007) The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg 104(1):193–197PubMedCrossRefGoogle Scholar
  12. 12.
    Smith SR et al (2015) Transversus abdominis plane blockade in laparoscopic colorectal surgery: a double-blind randomized clinical trial. Int J Colorectal Dis 30(9):1237–1245PubMedCrossRefGoogle Scholar
  13. 13.
    Abdallah FW et al (2013) Duration of analgesic effectiveness after the posterior and lateral transversus abdominis plane block techniques for transverse lower abdominal incisions: a meta-analysis. Br J Anaesth 111(5):721–735PubMedCrossRefGoogle Scholar
  14. 14.
    Blanco R, Ansari E, Fau-Girgis T, Girgis E (2015) Quadratus lumborum block for postoperative pain after caesarean section: a randomised controlled trial. Eur J Anaesthesiol (EJA) 32:812CrossRefGoogle Scholar
  15. 15.
    Kumar GD et al (2018) A comparative study of transversus abdominis plane block versus quadratus lumborum block for postoperative analgesia following lower abdominal surgeries: a prospective double-blinded study. Anesth Essays Res 12(4):919–923PubMedPubMedCentralGoogle Scholar
  16. 16.
    Yousef NK (2018) Quadratus lumborum block versus transversus abdominis plane block in patients undergoing total abdominal hysterectomy: a randomized prospective controlled trial. Anesth Essays Res 12(3):742–747PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Elsharkawy H (2017) Quadratus lumborum blocks. Adv Anesth 35(1):145–157PubMedCrossRefGoogle Scholar
  18. 18.
    Saito T et al (1999) Anatomical bases for paravertebral anesthetic block: fluid communication between the thoracic and lumbar paravertebral regions. Surg Radiol Anat 21(6):359–363PubMedCrossRefGoogle Scholar
  19. 19.
    Benetazzo L et al (2011) 3D reconstruction of the crural and thoracolumbar fasciae. Surg Radiol Anat 33(10):855–862PubMedCrossRefGoogle Scholar
  20. 20.
    Carney J et al (2011) Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks. Anaesthesia 66(11):1023–1030PubMedCrossRefGoogle Scholar
  21. 21.
    Willard FH et al (2012) The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat 221(6):507–536PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Visoiu M, Yakovleva N (2013) Continuous postoperative analgesia via quadratus lumborum block—an alternative to transversus abdominis plane block. Pediatr Anesth 23(10):959–961CrossRefGoogle Scholar
  23. 23.
    Murouchi T, Iwasaki S, Yamakage M (2016) Quadratus lumborum block: analgesic effects and chronological ropivacaine concentrations after laparoscopic surgery. Reg Anesth Pain Med 41:146PubMedCrossRefGoogle Scholar
  24. 24.
    Kadam VR (2013) Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol 29(4):550PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Baidya DK et al (2015) Quadratus lumborum block: an effective method of perioperative analgesia in children undergoing pyeloplasty. J Clin Anesth 27(8):694–696PubMedCrossRefGoogle Scholar
  26. 26.
    Chakraborty A, Goswami J, Patro V (2015) Ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a pediatric patient. A A Case Rep 4:34PubMedCrossRefGoogle Scholar
  27. 27.
    Kadam VR (2015) Ultrasound guided quadratus lumborum block or posterior transversus abdominis plane block catheter infusion as a postoperative analgesic technique for abdominal surgery. J Anaesthesiol Clin Pharmacol 31(1):130PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Shaaban M et al (2015) Bilateral continuous quadratus lumborum block for acute postoperative abdominal pain as a rescue after opioid-induced respiratory depression. A A case Rep 5(7):107–111PubMedCrossRefGoogle Scholar
  29. 29.
    Abrahams M, Derby R, Horn JL (2016) Update on ultrasound for truncal blocks: a review of the evidence. Reg Anesth Pain Med 41:275PubMedCrossRefGoogle Scholar
  30. 30.
    Blanco R et al (2016) Quadratus lumborum block versus transversus abdominis plane block for postoperative pain after cesarean delivery: a randomized controlled trial. Reg Anesth Pain Med. 41(6):757–762PubMedCrossRefGoogle Scholar
  31. 31.
    Cardoso JM et al (2018) Type II quadratus lumborum block for a sub-total gastrectomy in a septic patient. Braz J Anesthesiol.  https://doi.org/10.1016/j.bjan.2016.09.009 CrossRefGoogle Scholar
  32. 32.
    Carvalho R et al (2016) Quadratus lumborum block in chronic pain after abdominal hernia repair: case report. Braz J Anesthesiol (English Ed) 67(1):107–109Google Scholar
  33. 33.
    Chakraborty A, Khemka R, Datta T (2016) Ultrasound-guided truncal blocks: a new frontier in regional anaesthesia. Indian J Anaesth 60(10):703PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Dam M et al (2016) A transverse oblique approach to the transmuscular quadratus lumborum block. Anaesthesia 71(5):603–604PubMedCrossRefGoogle Scholar
  35. 35.
    Go R et al (2016) Truncal blocks for perioperative pain management: a review of the literature and evolving techniques. Pain Manage 6(5):455–468CrossRefGoogle Scholar
  36. 36.
    Murouchi T (2016) Quadratus lumborum block intramuscular approach for pediatric surgery. Acta Anaesthesiol Taiwan 54(4):135–136PubMedCrossRefGoogle Scholar
  37. 37.
    Spence NZ et al (2016) Quadratus lumborum catheters for breast reconstruction requiring transverse rectus abdominis myocutaneous flaps. J Anesth 30(3):506–509PubMedCrossRefGoogle Scholar
  38. 38.
    Ueshima HA-O, Otake H, Lin JA-O (2016) Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques. BioMed Res Int.  https://doi.org/10.1155/2017/2752876 CrossRefGoogle Scholar
  39. 39.
    Oksuz G et al (2017) Quadratus lumborum block versus transversus abdominis plane block in children undergoing low abdominal surgery: a randomized controlled trial. Reg Anesth Pain Med 42(5):674–679PubMedCrossRefGoogle Scholar
  40. 40.
    Dewinter G et al (2018) Quadratus lumborum block versus perioperative intravenous lidocaine for postoperative pain control in patients undergoing laparoscopic colorectal surgery: a prospective, randomized, double-blind controlled clinical trial. Ann Surg 268(5):769–775PubMedCrossRefGoogle Scholar
  41. 41.
    Carline L, McLeod GA, Lamb C (2016) A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks. Br J Anaesth 117(3):387–394PubMedCrossRefGoogle Scholar
  42. 42.
    Ishio J et al (2017) Evaluation of ultrasound-guided posterior quadratus lumborum block for postoperative analgesia after laparoscopic gynecologic surgery. J Clin Anesth 41:1–4PubMedCrossRefGoogle Scholar
  43. 43.
    Krohg A et al (2018) The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery: a randomized clinical trial. Anesth Analg 126(2):559–565PubMedCrossRefGoogle Scholar
  44. 44.
    Mieszkowski MM et al (2018) Evaluation of the effectiveness of the quadratus lumborum block type I using ropivacaine in postoperative analgesia after a cesarean section—a controlled clinical study. Ginekol Pol 89(2):89–96PubMedCrossRefGoogle Scholar
  45. 45.
    Okmen K, Metin Okmen B, Topal S (2018) Ultrasound-guided posterior quadratus lumborum block for postoperative pain after laparoscopic cholecystectomy: a randomized controlled double blind study. J Clin Anesth 49:112–117PubMedCrossRefGoogle Scholar
  46. 46.
    Vadivelu N et al (2014) Preventive analgesia for postoperative pain control: a broader concept. Local Reg Anesth 7:17–22PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery, Faculty of MedicineUniversité LavalQuébec CityCanada
  2. 2.Department of Anesthesiology and Critical Care Medicine, Faculty of MedicineUniversité LavalQuébec CityCanada
  3. 3.CHU de Québec – Université Laval Research Centre, Clinical and Evaluative Research PlatformQuébec CityCanada
  4. 4.CHU de Québec – Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care MedicineUniversité LavalQuébec CityCanada
  5. 5.Department of SurgeryCHU de Québec – Université LavalQuébecCanada

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