Melissa Boulianne, MD1, Pamela Paquet, MD1, Sebastien Drolet, MD, FRCSC2, Raymond Veilleux, MD, FRCPC3, David Simonyan, MSc4, Alexis F Turgeon, MD, FRCPC, MSc5. 1CHU de Quebec-Université Laval, 2CHU de Quebec – Department of General Surgery, 3CHU de Quebec – Department of Anesthesiology, 4CHU de Quebec – Department of Biostatistics, 5Department of Anesthesiology and Critical Care Medicine, and CHU de Québec – Université Laval Research Center – Université Laval, Population Health and Optimal Practices Research Unit.
INTRODUCTION: Postoperative pain following colorectal surgery requires significant opioid use. Recently, regional anesthesia has been proposed to improve pain relief and reduce opioid use. In this context, the posterior quadratus lumborum block (QL2) is newly employed but its effectiveness remains controversial.
METHODS: We conducted a randomized controlled trial evaluating the effect of quadratus lomborum block on pain control. In the QL2 group, an injection of 20 mL of ropivacaine 0.375% was performed on each side. A sham injection (superficial cutaneous puncture) was performed in the placebo group. The primary outcome was opioid administration at 24 hours. The secondary outcomes were opioid administration, pain (visual analogue scale), delay in resumption of intestinal transit, nausea and vomiting, and hospital length of stay. Sixty-two patients were required to evaluate a 50% reduction in opioid use (alpha 5%, beta 20%) with the QL2.
RESULTS: The population was composed of 63% men and 37% women aged of of 63 years old, on average. In the QL2 group, 100.2 mg (95%CI 68.9-131.5) of PO morphine equivalent were administered on average compared to 88.7 mg (95% CI 59.3 – 118.0) in the placebo group. (p = 0.80). Postoperative pain was better controlled in the placebo group than in the QL2 group (3.8 (95%CI 2.8-4.7) vs 5.7 (95%CI 4.7-6.6); (p = 0.005)). Other outcomes were comparable across groups.
CONCLUSION: In this trial, we did not observe a decrease in opioid administration with the posterior quadratus lomborum block regional anesthesia in a context of colorectal surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95388
Program Number: S040
Presentation Session: Colorectal I
Presentation Type: Podium