Does Ultrasound-Guided Quadratus Lumborum Block Improve Pain after Hysterectomy.

Abstract

Objective: Determine whether the quadratus lumborum block (QLB) is an effective adjunct to control postoperative pain during the first 24 hours after minimally invasive hysterectomy.

Methods: Prospective cohort observational study of patients who underwent laparoscopic or robotic hysterectomy. Patients either received a QLB or did not. Initial postoperative pain scores were recorded in the postanesthesia recovery area using a numeric rating scale. Patients were then called to collect 24-hour scores and analgesic medication usage. The primary outcome was the 3-hour pain score. Secondary analysis evaluated use of analgesic medication.

Results: Fifty patients were enrolled in the study: 25 patients in the no-QLB cohort and 25 patients in the QLB group. The median postoperative pain scores (out of 10) were 4, 2, and 6 at 1, 3, and 24 hours in the no-QLB group. Scores were 5 (P = .541), 3 (P = .418), and 6 (P = .358), respectively, in the QLB group. A total of 11 of 25 patients at 1 hour, 8 of 25 patients at 3 hours, and 21 of 25 patients at 24 hours used analgesia postoperatively in the no-QLB group, compared to 11 of 25 patients at 1 hour (P = 1.0), 18 of 25 patients at 3 hours (P = .005), and 23 of 25 patients at 24 hours (P = .384) in the QLB group. Opioid, acetaminophen, and ibuprofen usage was not significantly different between groups.

Conclusion: There was no significant pain difference between the no-QLB and QLB groups. Patients who received a QLB were more likely to receive pain medication 3 hours after surgery. Thus, the use of a QLB does not appear to be a suitable adjunct for postoperative pain.