Quadratus lumborum block for total abdominal hysterectomy: a double-blind, randomized, controlled trial.

Background/aim: The Quadratus lumborum block (QLB) is an interfascial block recommended for multimodal pain therapy after cesarean section in patients who cannot receive intrathecal morphine. We wanted to investigate whether QLB contributes to better analgesia after total abdominal hysterectomy (TAH). The study was registered on the website ClinicalTrials.gov (registration number NCT05765318).

Materials and methods: Patients scheduled for TAH were randomized into two groups of 30 members each. The treatment group received QLB, while the control group did not undergo any block. The primary outcome was the amount of morphine during the first 12 postoperative h. Secondary outcomes included the total amount of morphine for 24 h, time to the first request for additional analgesia, pain intensity at rest and during activity, frequency of nausea and vomiting, and the degree of sedation at 2, 6, 12, and 24 h postoperatively.

Results: Patients in the QLB group received significantly less morphine (4.13 mg) compared to the control group (9.73 mg) during the first 12 postoperative h (p < 0.001) and also during the first 24 h. The patients in the QLB group had longer time interval to the first breakthrough pain (7.87 h) compared to the control group (2.63 h) (p < 0.001), lower NRS scores at rest and during activity after 2, 12, and 24 h, and better satisfaction with provided pain relief during the first 24 h postoperatively.

Conclusion: QLB reduces postoperative morphine use and postoperative pain intensity on the NRS scale, both at rest and during activity, as part of multimodal pain therapy for TAH.