Analgesic Effect of Bilateral Subcostal Quadratus Lumborum Block in Laparoscopic Colorectal Surgery

NCT06653439 | Completed

• 1 other identifier: SQLB3CRS
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Effective postoperative pain management is crucial for promoting early recovery and ambulation following laparoscopic colorectal surgery. Regional anesthesia techniques, like interfascial plane blocks, are increasingly being used to achieve this. The quadratus lumborum block (QLB) is a relatively new approach in abdominal surgeries, providing significant pain relief by blocking both somatic and sympathetic nerves. In particular, the anterior QLB technique allows local anesthetic to spread to the thoracic paravertebral space, making it potentially more effective for postoperative analgesia. The hypothesis of this study is that bilateral subcostal anterior QLB can reduce both postoperative pain and opioid consumption in laparoscopic colorectal surgery.

Conditions

Anesthesia; Regional Anesthesia; Post Operative Pain

Keywords

Anesthesia; Nerve block; Colorectal surgery; Subcostal Anterior Quadratus Lumborum Block

Outcome Measures

Primary Outcomes (1)

• Cumulative opioid consumption in the first 24 hours after surgery

  The primary outcome will be defined as cumulative opioid consumption during the first 24 hours following surgery, which will be calculated in intravenous morphine milligram equivalents (IV-MME), encompassing both PCA-administered morphine and rescue intravenous tramadol, according to the standardized ESAIC conversion guidelines. Patients can request opioids via a PCA device when their NRS score is≥ 4.

  Postoperative day 1

Secondary Outcomes (14)

• Cumulative opioid consumption in the first 12 hours after surgery

  Postoperative 12 hours.

• Intraoperative Remifentanil Consumption

  The remifentanil consumption will be recorded from anesthesia induction until the patient is referred to the recovery unit, up to 150 minutes.

• Numerical Rating Scale Assessment of Postoperative Pain

  Postoperative day 1

• Time to First Opioid Demand via PCA

  Postoperative day 1

• Extent of Sensory Block

  From block administration to 30 minutes post-procedure.

Study Arms (2)

Group S-QLB

ACTIVE COMPARATOR

A bilateral S-QLB (20 ml, %0.25 bupivacaine, bilaterally) + IV morphine patient-controlled analgesia (PCA)

Procedure: Bilateral ultrasound guided Subcostal Quadratus Lumborum Block; Drug: IV morphine PCA

Group Control

ACTIVE COMPARATOR

IV morphine PCA

Procedure: Control; Drug: IV morphine PCA

Interventions

Bilateral ultrasound guided Subcostal Quadratus Lumborum Block PROCEDURE

Bilateral ultrasound-guided subcostal quadratus lumborum block (20 mL, 0.25% bupivacaine, bilaterally) will be performed. All patients will receive multimodal analgesia, including a single dose of IV tenoxicam 20 mg. Additionally, 15 mg/kg IV paracetamol (based on IBW) will be administered at skin closure and continued every 6 hours postoperatively. A standardized IV PCA protocol will be initiated using a PCA device programmed to deliver morphine boluses of 0.01-0.015 mg/kg (IBW), with a 6-minute lockout and a 4-hour maximum of 0.1-0.15 mg/kg (IBW). Upon arrival in the PACU, patients with a resting NRS ≥4 will receive titrated IV morphine boluses of 0.03 mg/kg (IBW; max 10 mg) every 10 minutes until pain is controlled. In the surgical ward, patients with breakthrough pain (NRS ≥4) despite PCA use will receive IV tramadol 1-1.5 mg/kg (IBW) in 50-100 mg slow doses, not exceeding 400 mg/day.All patients will receive 8 mg dexamethasone and 0.15 mg/kg ondansetron (IBW) for PONV prophylaxis.

Also known as: S-QLB group

Group S-QLB

Control PROCEDURE

Patients in this group will not undergo plane blocks. IV morphine PCA multimodal analgesia will be provided: all patients will receive a single dose of IV tenoxicam 20 mg. Additionally, 15 mg/kg IV paracetamol (based on IBW) will be administered at skin closure and continued every 6 hours postoperatively. A standardized IV PCA protocol will be initiated for all patients using a PCA device, programmed to deliver morphine boluses of 0.01-0.015 mg/kg (IBW), with a 6-minute lockout and a 4-hour maximum dose of 0.1-0.15 mg/kg (IBW). Upon arrival in PACU, patients with a resting NRS ≥4 will receive titrated IV morphine boluses of 0.03 mg/kg (IBW; max 10 mg) every 10 minutes until pain is controlled. In the ward, patients with breakthrough pain (NRS ≥4) despite PCA use will receive IV tramadol 1-1.5 mg/kg (IBW), administered slowly in 50-100 mg doses (max 400 mg/day). All patients will receive IV dexamethasone (8 mg) before induction and IV ondansetron (0.15 mg/kg IBW) near surgery end.

Also known as: Control group

Group Control

IV morphine PCA DRUG

A standardized IV PCA protocol will be initiated for all patients using a PCA device (Body Guard 575 pain manager, UK), programmed to deliver morphine boluses of 0.01-0.015 mg/kg (IBW), with a 6-minute lockout and a 4-hour maximum dose of 0.1-0.15 mg/kg (IBW). No basal infusion will be used.

Also known as: PCA

Group Control; Group S-QLB

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• They will be able to provide written informed consent.

You may not qualify if:

• They will have clinically significant cardiovascular or cerebrovascular disease.
• They will have severe hepatic, renal, or respiratory dysfunction. They will have known drug allergies. They will have a history of substance abuse. They will have chronic opioid use, defined as regular use of ≥15 mg oral morphine equivalent per day for at least 30 consecutive days within the past 3 months.
• They will have chronic pain syndromes (e.g., fibromyalgia, diabetic neuropathy, or chronic low back pain).
• They will have neuropsychiatric disorders or cognitive impairment that precludes effective communication with the investigators.

Sponsors & Collaborators

• Ondokuz Mayıs University: lead

Study Sites (1)

Ondokuz Mayis University

Samsun, 55139, Turkey (Türkiye)

Location

Related Publications (1)

• Turunc E, Dost B, Kaya C, Ustun YB, Bilgin S, Ozdemir E, Koksal E, De Cassai A, Elsharkawy H. Efficacy of anterior subcostal quadratus lumborum block for postoperative analgesia in laparoscopic colorectal surgery: a randomized controlled trial. Reg Anesth Pain Med. 2025 Oct 28:rapm-2025-107136. doi: 10.1136/rapm-2025-107136. Online ahead of print.

  PMID: 41151981 DERIVED

MeSH Terms

Conditions

Pain, Postoperative

Interventions

Control Groups; Passive Cutaneous Anaphylaxis

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Intervention Hierarchy (Ancestors)

Epidemiologic Research Design; Epidemiologic Methods; Investigative Techniques; Research Design; Methods; Skin Tests; Immunologic Tests; Clinical Laboratory Techniques; Diagnostic Techniques and Procedures; Diagnosis; Immunologic Techniques; Antigen-Antibody Reactions; Immune System Phenomena

Study Officials

• Esra Turunc

  Ondokuz Mayis University, School of Medicine, Department of Anesthesiology

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Masking Details: Researchers, surgeons and nurses, and those involved in study outcome analysis will not be aware of the randomization of the group. Due to the nature of the intervention, patient blinding was not feasible. Block quality and standardization will be performed by an anesthetist experienced in regional anesthesia for S-QLB block.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant professor

Model Details: A block randomization was performed by an independent physician using a computer-generated sequence via a web-based program.

Study Record Dates

• First Submitted: October 20, 2024
• First Posted: October 22, 2024
• Study Start: October 28, 2024
• Primary Completion: April 20, 2025
• Study Completion: May 1, 2025
• Last Updated: June 15, 2025

Record last verified: 2025-06

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)