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50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting
May 1 - 3, 2025 | Orlando, Florida
6561
ANTERIOR QUADRATUS LUMBORUM BLOCK PROVIDES NON-INFERIOR ANALGESIA COMPARED TO THORACIC EPIDURAL AFTER LAPAROSCOPIC HEMICOLECTOMY
Poster Presenter
Authors
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Scientific Abstracts > Regional Anesthesia
Anterior Quadratus Lumborum Block Provides Non-inferior Analgesia
Compared to Thoracic Epidural After Laparoscopic Hemicolectomy
Stephen Davies, MD; W. Michael Bullock, MD, PhD; Julie K. M. Thacker, MD; Karan Kumar, MD; Joshua Dooley, MD;
Hector Martinez-Wilson, MD, PhD; Jeff Gadsden, MD; Amanda H. Kumar, MD
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
Introduction
•Thoracic epidurals are an effective analgesic modality but are associated with several significant adverse effects1.
•Truncal blocks are an alternative analgesic option for abdominal surgery though studies have yielded heterogenous results.
•The anterior quadratus lumborum block (QLB) may provide analgesia in the T7-L1 distribution, including visceral analgesia via communication with the thoracolumbar fascia2.
•This is the first study to date to compare the clinical effectiveness of anterior QLB to thoracic epidural for laparoscopic or robotic-assisted hemicolectomy.
Methods
•Single-center observational cohort study in ASA 2-3 patients undergoing laparoscopic or robotic hemicolectomy.
•Assessment of non-inferior 48-hour cumulative opiate consumption for patients receiving bilateral QLB with liposomal bupivacaine versus thoracic epidural analgesia.
•30 patients were allocated to each cohort, and compared to an institution-specific historical matched cohort who received epidural analgesia.
•All patients received a standardized multimodal regimen per our ERAS protocol.
Results
•Cumulative opiate consumption at 48 hours was significantly lower in the QLB cohort (33 vs 61), p-value 0.004.
•No difference in pain scores or time to achieve sustained pain relief.
Discussion
•Patients who received bilateral anterior QLB had lower cumulative 48-hour opiate consumption compared to patients who received thoracic epidural analgesia.
•Other benefits observed in the QLB cohort include lower incidence of post-operative hypotension and nausea.
•The QLB cohort had a significantly shorter time to ambulation, time to discharge readiness, and decreased hospital LOS.
•The QLB cohort experienced very few sleep-related complaints.
•Anesthesia-related charges decreased by over 50% in those who received the QLB as compared to thoracic epidural.