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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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.
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