Quadratus Lumborum Block Versus Perioperative Intravenous Lidocaine for Postoperative Pain Control in Patients Undergoing Laparoscopic Colorectal Surgery: A Prospective, Randomized, Double-blind Controlled Clinical Trial

Geertrui Dewinter; Steve Coppens; Marc Van de Velde; André D'Hoore; Albert Wolthuis; Eva Cuypers; Steffen Rex

doi:10.1097/SLA.0000000000002888

Quadratus Lumborum Block Versus Perioperative Intravenous Lidocaine for Postoperative Pain Control in Patients Undergoing Laparoscopic Colorectal Surgery: A Prospective, Randomized, Double-blind Controlled Clinical Trial

Geertrui Dewinter^*, Steve Coppens, Marc Van de Velde, André D'Hoore, Albert Wolthuis, Eva Cuypers, Steffen Rex

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

OBJECTIVE: To investigate the comparative analgesic efficacy of systemic lidocaine and quadratus lumborum (QL) block in laparoscopic colorectal surgery.

BACKGROUND: Although epidural analgesia is the standard to control pain in patients undergoing open colorectal surgery, optimal analgesic management in laparoscopic surgery is less well-defined. There is need for effective and efficient alternatives to epidural analgesia for pain management in patients undergoing laparoscopic colorectal surgery.

METHODS: A total of 125 patients undergoing laparoscopic colorectal surgery were included in this randomized, double-blind controlled clinical trial. Patients randomly received an intravenous infusion with placebo plus a QL-block with placebo, a QL-block with ropivacaine 0.25% plus intravenous placebo, or intravenous lidocaine plus a QL-block with placebo. Postoperatively, all patients received patient-controlled intravenous anesthesia (PCIA) with morphine. Primary outcome parameter was the opioid consumption during the first 24 hours postoperatively. Secondary endpoints included severity of postoperative pain, time to return of intestinal function, incidence of postoperative nausea and vomiting, and length of hospital stay.

RESULTS: The QL-block was not superior to systemic lidocaine for the reduction of morphine requirements in the first 24 hours postoperatively {QL-group: 37.5 (28.4) mg [mean (standard deviation)] vs lidocaine group: 40.2 (25) mg, P = 0.15}. For the majority of secondary outcome parameters, no significant differences were found between the groups. Morphine consumption in the postanesthesia care unit, the number of PCIA-boli demanded by the patient, and the number of PCIA-boli delivered by the PCIA-pump during the first 24 hours postoperatively were lower in the placebo group.

CONCLUSIONS: In our trial, the QL-block did not provide superior postoperative analgesia when compared to systemic lidocaine in laparoscopic colorectal surgery.

TRIAL REGISTRATION: Eudra CT: 2014-001499-73; 31/7/2014.

Original language	English
Pages (from-to)	769-775
Number of pages	7
Journal	Annals of Surgery
Volume	268
Issue number	5
DOIs	https://doi.org/10.1097/SLA.0000000000002888
Publication status	Published - Nov 2018
Externally published	Yes

Keywords

Aged
Analgesia, Patient-Controlled
Analgesics, Opioid/administration & dosage
Anesthetics, Local/administration & dosage
Belgium
Colonic Diseases/surgery
Double-Blind Method
Female
Humans
Infusions, Intravenous
Laparoscopy/methods
Length of Stay/statistics & numerical data
Lidocaine/administration & dosage
Male
Middle Aged
Morphine/administration & dosage
Nerve Block/methods
Pain Management/methods
Pain Measurement
Postoperative Nausea and Vomiting/prevention & control
Prospective Studies
Rectal Diseases/surgery
Ropivacaine/administration & dosage
Treatment Outcome

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10.1097/SLA.0000000000002888

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Dewinter, G., Coppens, S., Van de Velde, M., D'Hoore, A., Wolthuis, A., Cuypers, E., & Rex, S. (2018). Quadratus Lumborum Block Versus Perioperative Intravenous Lidocaine for Postoperative Pain Control in Patients Undergoing Laparoscopic Colorectal Surgery: A Prospective, Randomized, Double-blind Controlled Clinical Trial. Annals of Surgery, 268(5), 769-775. https://doi.org/10.1097/SLA.0000000000002888

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title = "Quadratus Lumborum Block Versus Perioperative Intravenous Lidocaine for Postoperative Pain Control in Patients Undergoing Laparoscopic Colorectal Surgery: A Prospective, Randomized, Double-blind Controlled Clinical Trial",

abstract = "OBJECTIVE: To investigate the comparative analgesic efficacy of systemic lidocaine and quadratus lumborum (QL) block in laparoscopic colorectal surgery.BACKGROUND: Although epidural analgesia is the standard to control pain in patients undergoing open colorectal surgery, optimal analgesic management in laparoscopic surgery is less well-defined. There is need for effective and efficient alternatives to epidural analgesia for pain management in patients undergoing laparoscopic colorectal surgery.METHODS: A total of 125 patients undergoing laparoscopic colorectal surgery were included in this randomized, double-blind controlled clinical trial. Patients randomly received an intravenous infusion with placebo plus a QL-block with placebo, a QL-block with ropivacaine 0.25% plus intravenous placebo, or intravenous lidocaine plus a QL-block with placebo. Postoperatively, all patients received patient-controlled intravenous anesthesia (PCIA) with morphine. Primary outcome parameter was the opioid consumption during the first 24 hours postoperatively. Secondary endpoints included severity of postoperative pain, time to return of intestinal function, incidence of postoperative nausea and vomiting, and length of hospital stay.RESULTS: The QL-block was not superior to systemic lidocaine for the reduction of morphine requirements in the first 24 hours postoperatively {QL-group: 37.5 (28.4) mg [mean (standard deviation)] vs lidocaine group: 40.2 (25) mg, P = 0.15}. For the majority of secondary outcome parameters, no significant differences were found between the groups. Morphine consumption in the postanesthesia care unit, the number of PCIA-boli demanded by the patient, and the number of PCIA-boli delivered by the PCIA-pump during the first 24 hours postoperatively were lower in the placebo group.CONCLUSIONS: In our trial, the QL-block did not provide superior postoperative analgesia when compared to systemic lidocaine in laparoscopic colorectal surgery.TRIAL REGISTRATION: Eudra CT: 2014-001499-73; 31/7/2014.",

keywords = "Aged, Analgesia, Patient-Controlled, Analgesics, Opioid/administration & dosage, Anesthetics, Local/administration & dosage, Belgium, Colonic Diseases/surgery, Double-Blind Method, Female, Humans, Infusions, Intravenous, Laparoscopy/methods, Length of Stay/statistics & numerical data, Lidocaine/administration & dosage, Male, Middle Aged, Morphine/administration & dosage, Nerve Block/methods, Pain Management/methods, Pain Measurement, Postoperative Nausea and Vomiting/prevention & control, Prospective Studies, Rectal Diseases/surgery, Ropivacaine/administration & dosage, Treatment Outcome",

author = "Geertrui Dewinter and Steve Coppens and {Van de Velde}, Marc and Andr{\'e} D'Hoore and Albert Wolthuis and Eva Cuypers and Steffen Rex",

year = "2018",

month = nov,

doi = "10.1097/SLA.0000000000002888",

language = "English",

volume = "268",

pages = "769--775",

journal = "Annals of Surgery",

issn = "0003-4932",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "5",

}

Dewinter, G, Coppens, S, Van de Velde, M, D'Hoore, A, Wolthuis, A, Cuypers, E & Rex, S 2018, 'Quadratus Lumborum Block Versus Perioperative Intravenous Lidocaine for Postoperative Pain Control in Patients Undergoing Laparoscopic Colorectal Surgery: A Prospective, Randomized, Double-blind Controlled Clinical Trial', Annals of Surgery, vol. 268, no. 5, pp. 769-775. https://doi.org/10.1097/SLA.0000000000002888

Quadratus Lumborum Block Versus Perioperative Intravenous Lidocaine for Postoperative Pain Control in Patients Undergoing Laparoscopic Colorectal Surgery: A Prospective, Randomized, Double-blind Controlled Clinical Trial. / Dewinter, Geertrui; Coppens, Steve; Van de Velde, Marc et al.
In: Annals of Surgery, Vol. 268, No. 5, 11.2018, p. 769-775.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Quadratus Lumborum Block Versus Perioperative Intravenous Lidocaine for Postoperative Pain Control in Patients Undergoing Laparoscopic Colorectal Surgery

T2 - A Prospective, Randomized, Double-blind Controlled Clinical Trial

AU - Dewinter, Geertrui

AU - Coppens, Steve

AU - Van de Velde, Marc

AU - D'Hoore, André

AU - Wolthuis, Albert

AU - Cuypers, Eva

AU - Rex, Steffen

PY - 2018/11

Y1 - 2018/11

N2 - OBJECTIVE: To investigate the comparative analgesic efficacy of systemic lidocaine and quadratus lumborum (QL) block in laparoscopic colorectal surgery.BACKGROUND: Although epidural analgesia is the standard to control pain in patients undergoing open colorectal surgery, optimal analgesic management in laparoscopic surgery is less well-defined. There is need for effective and efficient alternatives to epidural analgesia for pain management in patients undergoing laparoscopic colorectal surgery.METHODS: A total of 125 patients undergoing laparoscopic colorectal surgery were included in this randomized, double-blind controlled clinical trial. Patients randomly received an intravenous infusion with placebo plus a QL-block with placebo, a QL-block with ropivacaine 0.25% plus intravenous placebo, or intravenous lidocaine plus a QL-block with placebo. Postoperatively, all patients received patient-controlled intravenous anesthesia (PCIA) with morphine. Primary outcome parameter was the opioid consumption during the first 24 hours postoperatively. Secondary endpoints included severity of postoperative pain, time to return of intestinal function, incidence of postoperative nausea and vomiting, and length of hospital stay.RESULTS: The QL-block was not superior to systemic lidocaine for the reduction of morphine requirements in the first 24 hours postoperatively {QL-group: 37.5 (28.4) mg [mean (standard deviation)] vs lidocaine group: 40.2 (25) mg, P = 0.15}. For the majority of secondary outcome parameters, no significant differences were found between the groups. Morphine consumption in the postanesthesia care unit, the number of PCIA-boli demanded by the patient, and the number of PCIA-boli delivered by the PCIA-pump during the first 24 hours postoperatively were lower in the placebo group.CONCLUSIONS: In our trial, the QL-block did not provide superior postoperative analgesia when compared to systemic lidocaine in laparoscopic colorectal surgery.TRIAL REGISTRATION: Eudra CT: 2014-001499-73; 31/7/2014.

AB - OBJECTIVE: To investigate the comparative analgesic efficacy of systemic lidocaine and quadratus lumborum (QL) block in laparoscopic colorectal surgery.BACKGROUND: Although epidural analgesia is the standard to control pain in patients undergoing open colorectal surgery, optimal analgesic management in laparoscopic surgery is less well-defined. There is need for effective and efficient alternatives to epidural analgesia for pain management in patients undergoing laparoscopic colorectal surgery.METHODS: A total of 125 patients undergoing laparoscopic colorectal surgery were included in this randomized, double-blind controlled clinical trial. Patients randomly received an intravenous infusion with placebo plus a QL-block with placebo, a QL-block with ropivacaine 0.25% plus intravenous placebo, or intravenous lidocaine plus a QL-block with placebo. Postoperatively, all patients received patient-controlled intravenous anesthesia (PCIA) with morphine. Primary outcome parameter was the opioid consumption during the first 24 hours postoperatively. Secondary endpoints included severity of postoperative pain, time to return of intestinal function, incidence of postoperative nausea and vomiting, and length of hospital stay.RESULTS: The QL-block was not superior to systemic lidocaine for the reduction of morphine requirements in the first 24 hours postoperatively {QL-group: 37.5 (28.4) mg [mean (standard deviation)] vs lidocaine group: 40.2 (25) mg, P = 0.15}. For the majority of secondary outcome parameters, no significant differences were found between the groups. Morphine consumption in the postanesthesia care unit, the number of PCIA-boli demanded by the patient, and the number of PCIA-boli delivered by the PCIA-pump during the first 24 hours postoperatively were lower in the placebo group.CONCLUSIONS: In our trial, the QL-block did not provide superior postoperative analgesia when compared to systemic lidocaine in laparoscopic colorectal surgery.TRIAL REGISTRATION: Eudra CT: 2014-001499-73; 31/7/2014.

KW - Aged

KW - Analgesia, Patient-Controlled

KW - Analgesics, Opioid/administration & dosage

KW - Anesthetics, Local/administration & dosage

KW - Belgium

KW - Colonic Diseases/surgery

KW - Double-Blind Method

KW - Female

KW - Humans

KW - Infusions, Intravenous

KW - Laparoscopy/methods

KW - Length of Stay/statistics & numerical data

KW - Lidocaine/administration & dosage

KW - Male

KW - Middle Aged

KW - Morphine/administration & dosage

KW - Nerve Block/methods

KW - Pain Management/methods

KW - Pain Measurement

KW - Postoperative Nausea and Vomiting/prevention & control

KW - Prospective Studies

KW - Rectal Diseases/surgery

KW - Ropivacaine/administration & dosage

KW - Treatment Outcome

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DO - 10.1097/SLA.0000000000002888

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SN - 0003-4932

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JO - Annals of Surgery

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Dewinter G, Coppens S, Van de Velde M, D'Hoore A, Wolthuis A, Cuypers E et al. Quadratus Lumborum Block Versus Perioperative Intravenous Lidocaine for Postoperative Pain Control in Patients Undergoing Laparoscopic Colorectal Surgery: A Prospective, Randomized, Double-blind Controlled Clinical Trial. Annals of Surgery. 2018 Nov;268(5):769-775. doi: 10.1097/SLA.0000000000002888