Analgesic Effect of Bilateral Subcostal Quadratus Lumborum Block in Laparoscopic Colorectal Surgery

Not Applicable

Completed

• Conditions: Anesthesia; Regional Anesthesia; Post Operative Pain
• Interventions: Procedure: Bilateral ultrasound guided Subcostal Quadratus Lumborum Block; Procedure: Control; Drug: IV morphine PCA

• Registration Number: NCT06653439
• Lead Sponsor: Ondokuz Mayıs University

Brief Summary

Effective postoperative pain management is crucial for promoting early recovery and ambulation following laparoscopic colorectal surgery. Regional anesthesia techniques, like interfascial plane blocks, are increasingly being used to achieve this. The quadratus lumborum block (QLB) is a relatively new approach in abdominal surgeries, providing significant pain relief by blocking both somatic and sympathetic nerves. In particular, the anterior QLB technique allows local anesthetic to spread to the thoracic paravertebral space, making it potentially more effective for postoperative analgesia. The hypothesis of this study is that bilateral subcostal anterior QLB can reduce both postoperative pain and opioid consumption in laparoscopic colorectal surgery.

Detailed Description

Postoperative pain management is a critical factor in enhancing recovery and ambulation following laparoscopic colorectal surgery. Effective analgesia is necessary to reduce complications, improve patient comfort, and shorten hospital stays. In this context, multimodal analgesia is a commonly used strategy that combines various analgesic drugs, such as paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids, to manage pain more effectively by targeting different pathways.

Although opioids are considered the gold standard for postoperative pain control, their use is associated with several undesirable side effects, including nausea, vomiting, dizziness, constipation, and respiratory depression. These opioid-related complications can delay recovery, increase patient discomfort, and extend hospital stays. Therefore, minimizing opioid consumption while still providing effective pain relief is a primary goal in postoperative pain management, particularly for surgeries such as laparoscopic colorectal procedures.

To achieve this goal, regional anesthesia techniques have gained increasing popularity. These techniques, such as interfascial plane blocks, have the potential to reduce opioid use and improve pain control by targeting specific nerve pathways. One of the more recent approaches is the quadratus lumborum block (QLB), which involves the injection of local anesthetics near the quadratus lumborum muscle. This block is particularly useful in abdominal surgeries because it can provide pain relief by affecting both somatic and sympathetic nerves, leading to broader and more effective pain coverage.

The QLB has four different approaches: anterior, lateral, posterior, and intramuscular. The anterior QLB is of particular interest in this setting because it involves the injection of local anesthetic between the quadratus lumborum and psoas muscles, potentially allowing the anesthetic to spread into the thoracic paravertebral space. This spread could result in the blockade of both the somatic nerves and the thoracic sympathetic chain, offering more comprehensive pain relief that is beneficial for abdominal surgeries like colorectal procedures.

The potential advantages of the anterior QLB in laparoscopic colorectal surgery include reduced postoperative pain, decreased opioid consumption, and fewer opioid-related side effects. Additionally, regional anesthesia techniques like QLB may reduce postoperative complications, including respiratory issues, which are particularly important in abdominal surgeries that involve the diaphragm and lower thoracic nerves.

In this study, the hypothesis is that bilateral subcostal anterior QLB, administered during laparoscopic colorectal surgery, will significantly reduce both postoperative pain and the need for opioids.

The aim of this study is to investigate the effects of Bilateral subcostal anterior QLB on postoperative acute pain scores (0-24 hours) and 24- hour opioid consumption in patients who underwent laparoscopic colorectal surgery. Our study, which the investigators think will contribute to the literature, was planned as a prospective, randomized, controlled, parallel-group study.

Patients will be divided into two groups:

Group S-QLB:

A bilateral S-QLB (40 ml 0.25% bupivacaine + 1:400.000 adrenaline) will be performed. In addition, IV morphine-PCA will be applied postoperatively for 24 hours.

Group Control :

IV morphine-PCA will be applied postoperatively for 24 hours.

Study Timeline

• Study First Submitted: 2024-10-20
• Study First Submitted QC: 2024-10-20
• Study First Posted: 2024-10-22
• Study Start: 2024-10-28
• Primary Completion: 2025-04-20
• Status Verified: 2025-05
• Study Completion: 2025-05-01
• Last Update Submitted: 2025-05-07
• Last Update Posted: 2025-05-09

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 60

Inclusion Criteria

• 18- 75 years old,
• patients classified as ASA I-III who have signed an informed consent form
• scheduled for elective laparoscopic colon surgery (partial or total)

Exclusion Criteria

• BMI >30 kg/m²
• Pregnancy
• Contraindication to regional anesthesia
• Presence of severe cardiac, hepatic, or cerebrovascular disease
• History of allergy to local anesthetics or systemic opioids
• History of chronic pain
• Patients with alcohol or drug dependence
• Patients unable to assess pain scores

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Group S-QLB	Bilateral ultrasound guided Subcostal Quadratus Lumborum Block	A bilateral S-QLB (40 ml, %0.25 bupivacaine, totally) + IV morphine patient-controlled analgesia (PCA)
Group S-QLB	IV morphine PCA	A bilateral S-QLB (40 ml, %0.25 bupivacaine, totally) + IV morphine patient-controlled analgesia (PCA)
Group Control	Control	IV morphine PCA
Group Control	IV morphine PCA	IV morphine PCA

Primary Outcome Measures

Name	Time	Method
Morphine consumption in the first 24 hours after surgery	Postoperative day 1	Morphine consumption in the first 24 hours after surgery will be measured. Patients can request opioids via a PCA device when their NRS score is≥ 4.

Secondary Outcome Measures

Name	Time	Method
Postoperative pain scores	Postoperative day 1	Pain status at rest and while activity will be assessed by NRS score at 0, 3, 6, 12, 18, and 24 hours after surgery. The NRS is an 11-point numeric scale that ranges from 0 to 10.
The incidences of postoperative nausea and vomiting (PONV)	Postoperative day 1	The severity of postoperative nausea and vomiting (PONV) will be assessed using a descriptive verbal rating scale at 0, 3, 6, 12, 18, and 24 hours after extubation. If a score of 3 or more, ondansetron 4 mg IV will be administered and will repeat after 8 hours if required. The PONV scale is 0 = no nausea; 1 = slight nausea; 2 = moderate nausea; 3 = vomiting once; and 4 = vomiting more than once.
Time of first analgesic request	Postoperative day 1	Time at which the first analgesic is requested
The number of patients who required rescue analgesia.	Postoperative day 1	The number of patients requiring rescue analgesics will be recorded over 24 hours.
The number of patients with complications	Postoperative 7 days on an average	The number of patients has any complications -directly related to the block or the drug used in the block- will be recorded
Intraoperative remifentanil consumption	The remifentanil consumption will be recorded from anesthesia induction until the patient is referred to the recovery unit, up to 150 minutes.	The total amount of remifentanil consumed will be recorded.

Trial Locations

Locations (1)

Ondokuz Mayis University; 🇹🇷 Samsun, Turkey