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

  • 2019 SAGES Oral
  • Published:
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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.

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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.

Author information

Author notes

  1. Mélissa Boulianne and Pamela Paquet were principal investigators and share the rank of first author.

Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, Université Laval, Québec City, QC, Canada

    Mélissa Boulianne, Sébastien Drolet, Alexandre Meunier & Jonathan Frigault

  2. Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada

    Pamela Paquet, Raymond Veilleux & Alexis F. Turgeon

  3. CHU de Québec – Université Laval Research Centre, Clinical and Evaluative Research Platform, Québec City, QC, Canada

    David Simonyan

  4. CHU de Québec – Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec City, Canada

    Alexis F. Turgeon

  5. Department of Surgery, CHU de Québec – Université Laval, 1050 avenue de la médecine, Pavillon Ferdinand-Vandry, Office 3370, Québec, QC, G1V 0A6, Canada

    Mélissa Boulianne

Authors
  1. Mélissa Boulianne
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  2. Pamela Paquet
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Corresponding author

Correspondence to Mélissa Boulianne.

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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.

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Boulianne, M., Paquet, P., Veilleux, R. et al. Effects of quadratus lumborum block regional anesthesia on postoperative pain after colorectal resection: a randomized controlled trial. Surg Endosc 34, 4157–4165 (2020). https://doi.org/10.1007/s00464-019-07184-0

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  • DOI: https://doi.org/10.1007/s00464-019-07184-0

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