# Quadratus lumborum block for postoperative pain management in patients undergoing ileostomy closure: a prospective, randomized controlled trial

## TL;DR

A study tested if a quadratus lumborum block helps reduce pain after ileostomy surgery but found no significant benefit compared to a placebo.

## Contribution

This is the first randomized controlled trial evaluating the analgesic efficacy of QL blocks specifically for ileostomy closure.

## Key findings

- QL block did not reduce rest pain scores at 6 hours post-surgery compared to placebo.
- QL group had slightly lower movement-induced pain at certain time points.
- Total opioid use and hospital stay were not significantly different between groups.

## Abstract

Quadratus lumborum (QL) block is used for multimodal analgesia following abdominal surgery. We introduced an ultrasound-guided QL block to treat postoperative pain for ileostomy closure. This study aimed to investigate the analgesic efficacy of the QL block compared to placebo after ileostomy closure.

Fifty-seven patients undergoing elective ileostomy closure were randomized (1:1) to the placebo or QL block group in this double-blind randomized controlled trial. After general anesthesia, a unilateral QL block was performed under ultrasound guidance. Opioid consumption and numeric rating scale (NRS, 0–10) pain scores were recorded at 2, 6, 12, 24, 48, and 72 hours postoperatively. The primary outcome was the NRS pain score at rest at 6 hours. Secondary outcomes included pain scores, rescue analgesics over 72 hours, Quality of Recovery-15 scores in 24 hours, complications, and length of hospital stay.

Baseline characteristics were similar among the 54 patients (27 per group) who completed the study, excluding three who dropped out. The QL block did not reduce NRS pain scores at rest at 6 hours (median [interquartile range], 5 [4–6] vs. 5 [3–6]; p=0.78). Over the 72-hour postoperative period, pain scores at rest remained comparable between the groups, while the QL group showed slightly lower movement-induced pain at certain time points. The QL group required fewer analgesics and antiemetics at certain intervals, but the total opioid use, length of hospital stay, and quality of recovery were not significantly different.

The QL block showed no meaningful advantage in postoperative analgesia compared to placebo for ileostomy closures.