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Effect of anterior quadratus lumborum block with ropivacaine on the immune response after laparoscopic surgery in colon cancer: a substudy of a randomized clinical trial
  1. Lukas Balsevicius1,2,
  2. Paulo C. M. Urbano1,
  3. Rune Petring Hasselager1,3,
  4. Ahmed Abdirahman Mohamud1,
  5. Maria Olausson1,
  6. Melina Svraka1,
  7. Kirsten L. Wahlstrøm1,
  8. Carolin Oppermann1,
  9. Dilara Seyma Gögenur1,
  10. Emma Rosenkrantz Hølmich1,
  11. Britt Cappelen1,
  12. Susanne Gjørup Sækmose4,
  13. Katrine Tanggaard5,
  14. Thomas Litman6,
  15. Jens Børglum5,7,
  16. Susanne Brix8 and
  17. Ismail Gögenur1,7
  1. 1 Department of Surgery, Zealand University Hospital, Koge, Denmark
  2. 2 Graduate School of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  3. 3 Euro-Periscope, Onco-Anaesthesiology Research Group (RG), European Society of Anaesthesiology, Brussels, Belgium
  4. 4 Department of Clinical Immunology, Zealand University Hospital, Koge, Denmark
  5. 5 Department of Anesthesiology and Intensive Care, Zealand University Hospital, Roskilde, Denmark
  6. 6 Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
  7. 7 Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  8. 8 Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
  1. Correspondence to Lukas Balsevicius, Department of Surgery, Zealand University Hospital Koge, Koge, Sjælland, Denmark; lukb{at}


Background Surgery induces a temporal change in the immune system, which might be modified by regional anesthesia. Applying a bilateral preoperative anterior quadratus lumborum block has proven to be a safe and effective technique in pain management after abdominal and retroperitoneal surgery, but the effect on the immune response is not thoroughly investigated.

Methods This study is a substudy of a randomized, controlled, double-blinded trial of patients undergoing laparoscopic hemicolectomy due to colon cancer. Twenty-two patients were randomized to undergo either a bilateral anterior quadratus lumborum nerve block with a total of 60 mL ropivacaine 0.375% or placebo with corresponding isotonic saline injections. The main objective of this exploratory substudy was to investigate the systemic immune response in the first postoperative day by examining changes in blood transcript levels (n=750) and stimulated secretion of cytokines (n=17) on ex vivo activation with microbial ligands and anti-CD3/CD28.

Results Using unsupervised data analysis tools, we observed no effect of the bilateral anterior quadratus lumborum nerve block on gene expression in immune cells (permutational multivariate analysis of variance using distance matrices: F=0.52, p=0.96), abundances of major immune cell populations (Wilcoxon rank-sum test: p>0.05), and stimulated cytokine secretion (Wilcoxon rank-sum test: p>0.05).

Conclusions Our study provides evidence that administration of bilateral anterior quadratus lumborum nerve block as a part of a multimodal analgesic regimen in an enhanced recovery after surgery for laparoscopic hemicolectomy in this cohort does not alter the systemic immune response.

Trial registration number


  • Anesthesia, Local
  • Injections, Spinal
  • Nerve Block

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors RPH, KT, SGS, JB and IG designed experiments; RPH, ERH, SGS, KT, JB and BC performed experiments; LB, AAM, MO, MS, KLW, CO, DSG, RPH, TL, PCMU and SB analyzed the data. LB, AAM, MO, MS, KLW, CO, DSG, SB and PCMU wrote the manuscript. All authors reviewed the manuscript. IG acts as guarantor.

  • Funding The authors declare that the research was conducted in the absence of any commercial or financial funding that could be construed as a potential conflict of interest. The Center for Surgical Science Transcriptomic core facility is funded by Aage and Johanne Louis-Hansen foundation (grant no. 21-2B-8305/ L 276).

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.