Shreya J Shetty, MD, Tiffany Weidner, MD, Hangge Patrick, MD, Tonia Young-Fadok, MD. Mayo Clinic, Scottsdale, AZ
Introduction: Quadratus lumborum (QL) blocks are effective for pain control after abdominal surgery, modifying somatic and visceral pain. Published descriptions are for anesthesiologist administration pre- or post-operatively. We present a pilot series of patients undergoing a novel intraoperative ultrasound-guided QL block by the surgeon.
Methods and Procedures: A patient undergoing a standard ultrasound guided QL3 block by an anesthesiologist established the baseline anticipated response, and procedure time. The procedure, performed under sedation preoperatively, required over 60 minutes. For this study, patients undergoing laparoscopic colorectal surgery were administered a lateral QL block (modified QL 1) under ultrasound guidance by the operating surgeon. 40 ml of a mixture (10 ml injectable liposomal bupivacaine suspension, 15ml 0.25% bupivacaine hydrochloride and 15ml normal saline) was injected bilaterally, after induction, skin preparation, draping, and prior to the operation. Post-operative narcotic use and pain VAS scores were documented.
Results: Six patients were administered a bi-lateral QL block intraoperatively. Procedures were: 3 laparoscopic sigmoid colectomies, one end ileostomy reversal, laparoscopic completion proctectomy with ileal pouch anal anastomosis, and a laparoscopic descending colectomy. Of the narcotic naïve patients, mean pain VAS on post op days 0, 1 and 2 were 4.5, 3.2 and 2.3 respectively within a multimodality pain management / enhanced recovery program, where standing orders prompting narcotic administration by nursing staff is pain VAS 5. All were discharged on POD 2 or 3 without narcotic prescriptions. Two of the 6 patients were chronic narcotic users, and they were discharged on their baseline narcotics, i.e. without additional narcotics. All intraoperative blocks were performed in less than 20 minutes.
Conclusion: A novel, surgeon-administered lateral QL block under ultrasound guidance, is feasible and provides post-operative pain control. Patients are discharged home on no / baseline narcotics. A randomized controlled trial is being constructed based on these striking findings.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88228
Program Number: P359
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster