Opioid Use Not Decreased With Anterior Quadratus Lumborum Block for Laparoscopic Hemicolectomy

Preoperative bilateral anterior quadratus lumborum nerve block in addition to multimodal analgesics was not found to reduce opioid consumption at 24 hours following laparoscopic hemicolectomy among patients with colon cancer compared with multimodal analgesics alone. These findings were published in Regional Anesthesia & Pain Medicine.

This randomized, controlled, double-blind study (TQL-block for Laparoscopic Hemicolectomy; ClinicalTrials.gov Identifier: NCT03570541) was initiated at Copenhagen University Hospital in 2018 and relocated to Zealand University Hospital in Denmark in 2019. Patients with colon cancer (N=64) undergoing laparoscopic or robot-assisted hemicolectomy were randomly assigned in a 1:1 ratio to receive preoperative bilateral anterior quadratum lumborum nerve blocks with 0.375% ropivacaine 60 mL (n=33) or an equal amount of isotonic saline (n=31) in addition to standardized general anesthesia with propofol and remifentanil. Patients were also administered a neuromuscular blocking agent. The primary outcome was morphine consumption during the first 24 hours after surgery.

The median age of study participants ranged from 69 (interquartile range [IQR], 64-73) to 71 (IQR, 62.5-73) years and mean BMI was approximately 27 kg/m². Physical status of most patients was American Society of Anesthesiologists classification II (75.8% in the treatment group and 58.1% in the placebo group), 33.3% and 19.4% underwent robot-assisted surgery, and 12.1% and 0.0% required extended surgery, respectively.

Within the first 24 hours following surgery, total opioid consumption was similar among patients in the treatment and placebo groups (129 mg vs 127.2 mg; P =.93).

No significant differences were observed between the treatment and placebo groups when assessing opioid requirements, time to first opioid dose, median pain scores during rest or activity as calculated in 6-hour intervals, or ability to ambulate.

Similarly, no significant differences were observed between the treatment and placebo groups for adverse events of nausea or vomiting, orthostatic hypotension or intolerance, or surgical complications (Clavien-Dindo scores ³3B).

The median length of hospital stay was numerically higher among patients undergoing bilateral anterior quadratum lumborum nerve block with active treatment compared with patients receiving placebo, but the difference was not significant (65.9 vs 50.1 h; P =.26).

Study authors conclude that a preoperative bilateral anterior quadratus lumborum nerve block did not decrease opioid consumption compared with placebo within the first 24 hours following hemicolectomy among patients with colon cancer. They further advise, “Thus, preoperative anterior [quadratus lumborum] block should not be part of standard analgesic treatment in laparoscopic minimally invasive colon cancer surgery in an [Enhanced Recovery After Surgery] setting.”