Quadratus lumborum catheters and multimodal analgesia:
a progressive opioid-sparing regimen for free flap breast reconstruction
Kathryn Breslin, MD;Bryant Tran, MD; Santosh Kale, MD
Virginia CommonweathUniversity Health System Department of Anesthesiology
Major breast reconstruction requires multiple large skin incisions and can make the recovery period quite painful. Many patients report that the most significantpain isin the abdomen where the tissue is harvested for the reconstruction.This study aims to assess the efficacy of the QL block for pain management in breast reconstruction surgery
The study is retrospective chart review which consists of patients who have undergone major breast reconstruction surgery by Dr. Santosh Kale, a plastic surgeon at VCU Health Systems, during a time period between 2013 and 2017. The study populationwas divided into two groups; the first group consists of patients who did not receive regional anesthesia in the form of aQL block. The second group consists of patients who did receive the QL block. Post-operative opioid consumption was documented in oral morphine equivalents. Average hospital length of staywas also assessed.Although length of stay is influenced by multiple factors, adequate pain management does facilitate shorter hospital stays.
A preliminary subset analyses including 10 patients in each group. Exclusion criteria included patients under age 18,patients withDIEP flap failure orwho required additional operating room procedures, such as for bleeding or infection, and patients who were taking opioids prior to surgery. From the subset of data, the average opioid consumption in the QL group was 25.4mg, SD of 17.6while in the non-QL group consumption was 44.6mg, SD of 22.05.These results were statistically significant using a t-tailed test with a p-value of 0.04.The average length of hospital stay for the QL group was 3.2 days, SD 0.41 and 4.4 days, SD 1.95 in the non-QL group. These results were not statistically significant using a t-tailed test with a p-value of 0.07.