QL Block for Postoperative Pain in Fibroid Surgery

Overseen By Catherine P Haering, BA

Age: 18 - 65

Sex: Female

Trial Phase: Phase 4

Sponsor: Joseph Findley MD

Must not be taking: Opioids

Disqualifiers: Anxiety, Depression, Coagulopathies, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 2

Duration: 1 week

80 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether a QL block, an anesthetic injection in a lower back muscle, can effectively reduce pain after surgery to remove uterine fibroids. Participants will be randomly assigned to receive either a real QL block or a sham injection, along with standard pain care. The goal is to determine if the QL block provides better pain relief compared to not receiving it. Individuals with uterine fibroids who require surgery to remove them, while keeping the uterus intact, may be suitable for this trial. As a Phase 4 trial, this research aims to understand how this FDA-approved and effective treatment can benefit more patients.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, if you use chronic opioids, you may not be eligible to participate.

What is the safety track record for the QL Block?

Research shows that the quadratus lumborum (QL) block is safe and well-tolerated for managing post-surgical pain. Studies have found it provides effective pain relief for several hours after a procedure. Importantly, compared to other pain management methods like bupivacaine infiltration, the QL block reduces pain more effectively.

Further evidence suggests that QL blocks are safe and can decrease the need for opioids, which often cause side effects. In surgeries such as hernia and abdominal procedures, QL blocks have proven both safe and effective. As this technique becomes a standard part of anesthesia care, its safety remains well-recognized. ^{1 2 3 4 5}

Why are researchers enthusiastic about this study treatment?

Unlike the standard of care for postoperative pain management in fibroid surgery, which often relies on oral medications like opioids or NSAIDs, the QL Block offers a targeted approach. This technique involves injecting Bupivacaine directly into the quadratus lumborum muscle, which may provide more localized and effective pain relief. Researchers are excited because this method could minimize the need for systemic pain medications, potentially leading to fewer side effects and a faster recovery.

What evidence suggests that the QL block is effective for reducing postoperative pain in fibroid surgery?

Research has shown that the quadratus lumborum (QL) block can greatly reduce post-surgery pain. Studies found that patients who received a QL block experienced less pain than those who did not. This method is particularly beneficial for surgeries in the lower abdomen and pelvis, such as uterine fibroid removal. In this trial, one group of participants will receive a QL block with Bupivacaine, which may provide better pain relief than other methods, like injecting pain medicine directly into the surgical area. Patients required less pain medication after receiving a QL block. This evidence supports the QL block as an effective way to manage pain after fibroid surgery. ^{2 6 7 8 9}

Who Is on the Research Team?

Joseph Findley, MD

Principal Investigator

University Hospitals

Are You a Good Fit for This Trial?

This trial is for individuals needing surgery to remove uterine fibroids who can follow the study's procedures and are available throughout the study. They must understand and sign a consent form. It excludes those with anxiety, depression, blood clotting issues, chronic pain or opioid use, non-English speakers, and those with a BMI over 38.

Inclusion Criteria

I am willing and able to follow all study rules and be available for its duration.

I need surgery for uterine fibroids but want to keep my uterus.

Provision of signed and dated informed consent form

Exclusion Criteria

I have a blood clotting disorder.

I have been diagnosed with anxiety or depression.

Illiteracy due to inability to read and understand plain questionnaire

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo a myomectomy procedure with or without a QL block for postoperative pain management

1 week

1 visit (in-person)

Follow-up

Participants are monitored for pain levels and satisfaction with pain management up to 48 hours after discharge

1 week

1 visit (virtual)

What Are the Treatments Tested in This Trial?

Interventions

• QL Block

Trial Overview The trial tests if a QL block—an anesthetic injection in the lower back—reduces post-surgery pain after myomectomy (fibroid removal). Participants will either receive this block along with standard care or just standard care alone. Assignment to these groups is random.

How Is the Trial Designed?

Group I: QL Block with Bupivacaine Experimental Treatment 1 Intervention

Participants will get a QL block using 30cc Bupivacaine bilaterally in quadratus lumborum muscle (60cc total).

Group II: Control Placebo Group 1 Intervention

Participants will get a sham injection of 30cc saline bilaterally in quadratus lumborum muscle (60cc total).

Who Is Running the Clinical Trial?

Joseph Findley MD

Lead Sponsor

Trials

1

Recruited

80+

Published Research Related to This Trial

The quadratus lumborum (QL) block is an effective postoperative analgesic technique for major laparotomy, resulting in low pain scores and reduced opioid consumption on the first day after surgery.

This method provides sensory block up to the T8-L1 levels, indicating its potential for effective pain management in abdominal surgeries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. Kadam, VR.[2022]

In a study of 60 female patients undergoing total abdominal hysterectomy, bilateral quadratus lumborum (QL) block resulted in significantly lower consumption of opioids (fentanyl and morphine) compared to bilateral transverse abdominis plane (TAP) block.

Patients receiving the QL block reported lower pain scores at all postoperative time points and experienced a longer duration of analgesia, indicating that QL block is more effective for pain management after this type of surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Patients Undergoing Total Abdominal Hysterectomy: A Randomized Prospective Controlled Trial. Yousef, NK.[2022]

Bilateral quadratus lumborum (QL) block provided significant pain relief for a 43-year-old woman after uterine artery embolization, reducing her pain score from 8/10 to 3/10 within an hour and maintaining low pain levels (2-3/10) for 24 hours without the need for additional analgesics.

The study suggests that QL block could be a highly effective alternative for managing acute postoperative pain after uterine artery embolization, potentially reducing reliance on opioids and improving patient comfort.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Quadratus lumborum block in management of severe pain after uterine artery embolization. Ben-David, B., Kaligozhin, Z., Viderman, D.[2019]

In a study of 60 patients undergoing lumbar disc herniation surgery, the quadratus lumborum block (QLB) significantly reduced postoperative pain scores at 0 and 2 hours compared to a control group, indicating its efficacy in pain management.

Patients receiving the QLB reported higher satisfaction and required less rescue analgesia, while also experiencing fewer instances of nausea, suggesting that QLB not only improves pain control but also enhances overall patient comfort after surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The efficacy of ultrasound-guided anterior quadratus lumborum block for pain management following lumbar spinal surgery: a randomized controlled trial. Alver, S., Bahadir, C., Tahta, AC., et al.[2022]

In a study of 80 patients undergoing total hip arthroplasty, the quadratus lumborum (QL) block significantly reduced pain scores and opioid consumption for up to 48 hours post-surgery compared to a control group without the block.

Patients receiving the QL block reported higher satisfaction scores, indicating that this technique not only provides effective pain relief but also enhances the overall patient experience after surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Anterior quadratus lumborum block analgesia for total hip arthroplasty: a randomized, controlled study. Kukreja, P., MacBeth, L., Sturdivant, A., et al.[2021]

The quadratus lumborum (QL) block technique, used in two patients undergoing total laparoscopic hysterectomy, significantly reduced the need for opioids during the perioperative period and improved pain management in the first 24 hours post-surgery.

Both patients reported high satisfaction with their pain relief, suggesting that QL block could be an effective component of multimodal analgesia for laparoscopic surgeries, although more research is needed to optimize its application.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound-guided anterior and posterior quadratus lumborum block for analgesia after laparoscopic hysterectomy. Singh, N., Rao, PB., Elayat, A.[2021]

The Quadratus lumborum (QL) block significantly reduces opioid requirements in patients undergoing cesarean deliveries and renal surgeries, based on a systematic review of 22 studies.

QL block may provide effective postoperative analgesia for up to 24 hours, although evidence for its effectiveness in other types of surgeries is limited and further studies are needed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Single injection Quadratus Lumborum block for postoperative analgesia in adult surgical population: A systematic review and meta-analysis. Jin, Z., Liu, J., Li, R., et al.[2021]

In a study involving 36 women undergoing elective cesarean sections, the intramuscular quadratus lumborum block (QLBi) did not significantly extend the time to first postoperative analgesic use compared to a placebo, indicating limited effectiveness for pain relief.

The results suggest that the specific concentration and volume of ropivacaine used in the QLBi may not provide substantial benefits for postoperative analgesia after cesarean sections.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness of the intramuscular quadratus lumborum block in postoperative analgesia after cesarean section with vertical incision: a randomized, double-blinded placebo-controlled study. Yoshida, K., Tanaka, S., Watanabe, K., et al.[2022]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40454255/

Enhanced Postoperative Pain Management: A ... The QL block proved more effective than intraperitoneal and periportal bupivacaine infiltration in reducing postoperative pain scores for 6 hours.

2. frontiersin.org frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1654019/full

Efficacy of bilateral quadratus lumborum block with ... This study aims to evaluate whether bilateral QL blocks with liposomal bupivacaine can optimize postoperative pain management while reducing analgesic ...

3. journals.lww.com journals.lww.com/md-journal/fulltext/2024/01260/efficacy_of_quadratus_lumborum_block_in_the.21.aspx

Efficacy of quadratus lumborum block in the treatment of... The results showed that the QLB group could significantly reduce the VAS score 24 hours after the operation as compared with the control group ( ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11806731/

Postoperative Analgesic Effects of Quadratus Lumborum ... It has been shown to be effective in adult patients undergoing lower abdominal surgery, offering improved postoperative pain scores and reduced ...

5. brieflands.com brieflands.com/journals/aapm/articles/159545

Anesthesiology and Pain Medicine This study demonstrated that the QL block is more successful in providing prolonged and efficient analgesia, as indicated by reduced VAS scores, accompanied by ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12500571/

Efficacy of bilateral quadratus lumborum block with ... Additionally, existing evidence indicates that bilateral quadratus lumborum (QL) blocks provide more effective postoperative pain relief than ...

7. medsearchglobal.com medsearchglobal.com/antistudydetail/NCT05979493

Postoperative Pain - NCT05979493 - Joseph Findley MD This study aims to determine the efficacy of a quadratus lumborum (QL) block in decreasing postoperative pain in patients undergoing myomectomy for uterine ...

8. journals.lww.com journals.lww.com/njcp/fulltext/2022/25090/posterior_quadratus_lumborum_block_versus.12.aspx

Posterior Quadratus Lumborum Block Versus ... The study results showed that both posterior QLB and TAPB provided a safe and effective postoperative analgesia after inguinal hernia surgery.

9. researchgate.net researchgate.net/publication/374463666_Ultrasound-guided_quadratus_lumborum_block_a_powerful_way_for_reducing_postoperative_pain

(PDF) Ultrasound-guided quadratus lumborum block QL block provides effective pain management after abdominal surgery; helps reduce the need for opioids, which can have side effects ...