Effect of Preoperative Bilateral Ultrasound-Guided Quadratus Lumborum Nerve Block on Quality of Recovery After Minimally Invasive Hysterectomy in an Enhanced Recovery After Surgery (ERAS) Setting

J Minim Invasive Gynecol. 2024 Sep;31(9):769-777. doi: 10.1016/j.jmig.2024.05.019. Epub 2024 May 25.

Abstract

Study objective: To assess the effect of preoperative bilateral ultrasound-guided quadratus lumborum nerve block (QLB) on quality of recovery after minimally invasive hysterectomy, in an enhanced recovery after surgery setting.

Design: Randomized, controlled, double-blinded trial (Canadian Task Force level I).

Setting: University-affiliated tertiary medical center.

Patients: All women undergoing an elective robotic or laparoscopic hysterectomy. Women with chronic pain, chronic anticoagulation, and body mass index >50 kg/m2 were excluded.

Intervention: Patients were randomized with a 1:1 allocation, to one of the following 2 arms, and stratified based on robotic versus laparoscopic approach. 1. QLB: QLB (bupivacaine) + sham local trocar sites infiltration (normal saline) 2. Local infiltration: sham QLB (normal saline) + local infiltration (bupivacaine) MEASUREMENTS AND MAIN RESULTS: The primary outcome was defined as the quality of recovery score based on the validated questionnaire Quality of Recovery, completed 24 hours postoperatively. Secondary outcomes included dynamic pain scores, accumulated opioid consumption up to 24 hours, postoperative nausea and vomiting, surgical complications, length of hospital stay, time to first pain medication administration in the postanesthesia care unit, and adverse events. A total of 76 women were included in the study. Demographic characteristics were similar in both groups. Median age was 44 years (interquartile range 39-50), 47% of the participants were African American, and mean body mass index was 32.8 kg/m2 (standard deviation [SD] 8.1). The mean Quality of Recovery score was 179.1 (SD ± 10.3) in the QLB and 175.6 (SD ± 9.7) for the local anesthesia group (p = .072). All secondary outcomes were comparable between groups.

Conclusions: QLBs do not significantly improve quality of recovery after elective robotic or laparoscopic hysterectomy compared with local anesthetic port site infiltration.

Keywords: Minimally invasive hysterectomy; Quadratus lumborum block.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Abdominal Muscles / innervation
  • Adult
  • Anesthetics, Local / administration & dosage
  • Bupivacaine / administration & dosage
  • Double-Blind Method
  • Enhanced Recovery After Surgery*
  • Female
  • Humans
  • Hysterectomy* / methods
  • Laparoscopy* / methods
  • Length of Stay / statistics & numerical data
  • Middle Aged
  • Nerve Block* / methods
  • Pain, Postoperative* / prevention & control
  • Robotic Surgical Procedures* / methods
  • Ultrasonography, Interventional* / methods

Substances

  • Bupivacaine
  • Anesthetics, Local