Impact of preoperative quadratus lumborum block on postoperative opioid consumption after laparoscopic hysterectomy: a double-blind randomized controlled trial

BACKGROUND: Gynecologic enhanced recovery after surgery (ERAS) pathways have been developed to reduce postoperative narcotic use through multimodal pain management. While incisional injection of local anesthetic is standard practice, regional nerve blockades using liposomal agents are emerging as a promising adjunct technique for post-laparoscopy pain. Current data are conflicting regarding the benefits of regional nerve blocks on postoperative pain after laparoscopic hysterectomy. OBJECTIVES: To determine the impact of preoperative quadratus lumborum (QL) block on postoperative pain following laparoscopic hysterectomy. Our primary outcomes will be intraoperative and immediate postoperative opioid use (within 24 hours). Secondary outcomes will include pain scores, functional impact of pain, and postoperative complications. STUDY DESIGN: This is a prospective, double-blind, randomized-controlled trial comparing opioid use in women undergoing laparoscopic hysterectomy who receive a preoperative QL block to local injection. Seventy-six patients undergoing laparoscopic or robotic hysterectomy will be randomized to the study arm, preoperative QL block with liposomal bupivacaine and intraoperative placebo incisional injection of 0.9% saline, or the control arm, preoperative sham QL block with 0.9% saline and intraoperative incisional injection of 0.25% bupivacaine. Outcomes will be measured at several timepoints: intraoperative, postoperative prior to discharge, and 1, 3, 5, 14 days, and 4-6 weeks postoperatively. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov identifier is NCT06709716.