Impact of Preoperative Quadratus Lumborum Block on Postoperative Opioid Consumption After Laparoscopic Hysterectomy: a Double-blinded Randomized Controlled Trial
Walter Reed National Military Medical Center
Summary
The goal of this clinical trial is to learn if preoperative nerve block (quadratus lumborum \[QL\] block) works to improve pain control during and after laparoscopic hysterectomy. The main questions it aims to answer are: Does QL block decrease the amount of narcotic medication needed during surgery? Does QL block decrease the amount of narcotic medication needed after surgery? Researchers will compare QL block to local injection of a numbing medication at each incision site (the current standard practice) to see if QL block works to decrease surgical pain. Participants will be randomly assigned to receive one of the two following interventions: 1. QL block before surgery with a long-acting numbing medicine (liposomal bupivacaine) and then injection of placebo (saline) at each incision site in the operating room. 2. QL block before surgery with placebo (saline) and then injection of local numbing medicine (bupivacaine) at each incision site in the operating room. Participants will also: * Visit the clinic/hospital for a pre-operative appointment, the surgical procedure, and a 4-6 week post-operative appointment (all standard visits even if not participating in research) * Complete a questionnaire electronically, or by phone, that takes \<10 minutes at the pre-operative appointment and on postoperative days 1, 3, 5, 14, and 4-6 weeks.
Description
Context: (Background) Given the opioid epidemic, gynecologic enhanced recovery after surgery (ERAS) pathways have been developed to reduce post-operative narcotic use through multimodal pain regimens and pre-surgical anesthetic adjuncts. While local anesthetic injection at trocar incision sites has long been accepted as a standard practice to decrease postoperative pain in laparoscopic surgery, including hysterectomy, regional nerve blockades are emerging as a promising adjunct technique for management of perioperative pain. At this time, the data evaluating the effect of regional nerve blocks…
Eligibility
- Age range
- 18+ years
- Sex
- Female
- Healthy volunteers
- No
Inclusion Criteria: * 18 years or older * scheduled to undergo laparoscopic hysterectomy * able to speak and understand English * DEERs eligible (eligible for healthcare within military heath system) * Owning a phone that can receive text messages or having internet access to complete questionnaires Exclusion Criteria: * pre-operative opioid use * pre-operative pain management clinic patient * planned concomitant prolapse or incontinence procedure * planned concomitant non-gynecologic abdominal procedure (i.e. hernia repair) * inability to receive liposomal or non-liposomal bupivacaine * in…
Interventions
- DrugQuadratus Lumborum Block (QLB)
Pre-operative quadratus lumborum block with liposomal bupivacaine
- DrugQuadratus lumborum block
Pre-operative quadratus lumborum block with saline
- DrugLocal Anesthetic Solution
Intraoperative injection of 0.25% bupivacaine at each incision site
- DrugLocal Anesthetic Solution
Intraoperative injection of saline at each incision site.
Location
- Walter Reed National Military Medical CenterBethesda, Maryland