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Transmuscular quadratus lumborum block for total laparoscopic hysterectomy: a double-blind, randomized, placebo-controlled trial
  1. Christian Hansen1,
  2. Mette Dam1,
  3. Martin Vedel Nielsen1,
  4. Katrine B Tanggaard1,
  5. Troels Dirch Poulsen1,
  6. Thomas Fichtner Bendtsen2 and
  7. Jens Børglum1,3
  1. 1Department of Anesthesiology and Intensive Care, Zealand University Hospital, Roskilde, Denmark
  2. 2Department of Anesthesiology, Aarhus Universitetshospital, Aarhus, Denmark
  3. 3Department of Clinical Medicine, Faculty of Health and Clinical Science, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Jens Børglum, Department of Anesthesiology and Intensive Care, Zealand University Hospital, Roskilde 4000, Denmark; jens.borglum{at}gmail.com

Abstract

Background The population of patients scheduled for total laparoscopic hysterectomy at our surgical center is heterogeneous concerning a multitude of demographic variables such as age, collateral surgery and malign or benign pathogenesis. A common denominator is moderate to severe postoperative pain and a substantial opioid consumption. A recent procedure specific postoperative pain management (PROSPECT) review found no gain from the regional techniques included. The transmuscular quadratus lumborum (TQL) block has shown promising results in recent trials for other types of surgery. The aim of the current study was to investigate the analgesic efficacy of the ultrasound-guided TQL block for total laparoscopic hysterectomy.

Methods We enrolled 70 patients and randomly allocated participants to preoperative bilateral ultrasound-guided TQL block with either 60 mL 0.375% ropivacaine or 60 mL isotonic saline. Preoperatively, all patients received the TQL block (active or placebo) as well as a standardized multimodal analgesic regimen consisting of oral paracetamol, ibuprofen and dexamethasone. Intraoperatively, intravenous sufentanil 0.2 µg/kg was administered 30 min prior to emergence.

Primary outcome Opioid consumption during the first 12 postoperative hours.

Secondary outcomes Pain scores, times to first opioid demand and first ambulation, nausea and vomiting, and total opioid consumption during the first 24 postoperative hours.

Results No significant intergroup differences were observed for any outcome. Mean (SD) oral morphine equivalent consumption the first 12 postoperative hours was 58.4 mg (48.3) vs 62.9 mg (48.5), p=0.70, for group ropivacaine versus group saline.

Conclusion Preoperative bilateral ultrasound-guided TQL block did not reduce opioid consumption after total laparoscopic hysterectomy.

Trial registration numbers NCT 03650998, EudraCT (2017-004593-34).

  • anesthesia
  • local
  • pain management
  • ultrasonography
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Footnotes

  • Contributors CH: Planning, designing, conducting, acquisition of data, analyzing data, reporting, interpreting data and writing the manuscript. MD: Planning, conducting, interpreting data and writing the manuscript. MVN: Planning, conducting, interpreting data and writing the manuscript. KBT: Planning, conducting, interpreting data and writing the manuscript. TDP: Planning, conducting, interpreting data and writing the manuscript. TFB: Planning, interpreting data and writing the manuscript. JB: Planning, designing, conducting, acquisition of data, analyzing data, reporting, interpreting data and writing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The trial was approved by The Regional Ethics Committee (SJ-661) and the Danish Data Protection Agency.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. If request for data is received, we will consider this after close consultation with Region Zealand Ethics Committee, Denmark.

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