Quadratus Lumborum Block for Postoperative Pain

Overseen By Candice E Jones-Cox, MD

Age: 18+

Sex: Female

Trial Phase: Phase 4

Sponsor: Walter Reed National Military Medical Center

Must not be taking: Opioids

Disqualifiers: Opioid use, Pain clinic, 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: 4

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if a preoperative quadratus lumborum block (a nerve block that numbs specific muscles) can better control pain during and after a laparoscopic hysterectomy. Researchers seek to find out if this method reduces the need for narcotic medication compared to the standard practice of local numbing injections at the incision sites. Participants will be randomly assigned to receive either the nerve block with a placebo at incision sites or a placebo nerve block with standard numbing injections. This trial may suit individuals scheduled for a laparoscopic hysterectomy who do not use opioids before surgery and can complete follow-up questionnaires online or via text. As a Phase 4 trial, this research helps to understand how an already FDA-approved and effective treatment can benefit more patients.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you use opioids before surgery or if you cannot take certain pain medications like bupivacaine, NSAIDs, acetaminophen, or oxycodone.

What is the safety track record for the Quadratus Lumborum Block?

Research has shown that the quadratus lumborum (QL) block with liposomal bupivacaine is generally well-tolerated. Studies have found that this method provides effective and long-lasting pain relief, often reducing the need for opioids after surgery. This approach manages pain effectively without causing major side effects.

For gynecologic surgeries, QL blocks have successfully controlled post-operative pain. Specifically, using liposomal bupivacaine in these blocks has decreased the amount of pain medication needed after surgery. This is encouraging for those who want to limit opioid use while still managing pain effectively.

These studies have reported no serious side effects related to the QL block with liposomal bupivacaine, offering reassurance about its safety for those considering this pain management option during surgery. ^{1 2 3 4 5}

Why are researchers enthusiastic about this study treatment?

Researchers are excited about the Quadratus Lumborum Block for postoperative pain because it may offer a more effective way to manage pain after surgery. Unlike standard treatments that often involve systemic opioids or nonsteroidal anti-inflammatory drugs (NSAIDs), this approach uses a targeted nerve block with liposomal bupivacaine, which could provide longer-lasting pain relief with fewer side effects. The use of liposomal bupivacaine allows for a slow and sustained release of the anesthetic, potentially reducing the need for additional pain medications and enhancing patient recovery. By directly targeting the nerves near the surgical site, this method aims to improve pain management while minimizing the systemic impact, making it a promising alternative to current pain relief options.

What evidence suggests that the Quadratus Lumborum Block is effective for postoperative pain control during and after laparoscopic hysterectomy?

Research has shown that the quadratus lumborum (QL) block effectively reduces pain after surgery. Studies have found that this nerve block decreases the need for opioid painkillers after surgeries such as hip operations and cesarean sections. In one study, patients who received the QL block reported less pain both at rest and during movement. Another study on laparoscopic hysterectomy found that the QL block reduced opioid use and postoperative pain. In this trial, one group of participants will receive a preoperative QL block with liposomal bupivacaine, which could offer better pain control after surgery. Another group will receive a sham preoperative QL block with a placebo and an intra-operative injection with bupivacaine. ^{5 6 7 8 9}

Who Is on the Research Team?

Kathryn A Edmonds, MD

Principal Investigator

Walter Reed National Military Medical Center

Are You a Good Fit for This Trial?

This trial is for individuals scheduled for laparoscopic hysterectomy who are interested in better pain control. Participants must attend standard pre-operative and post-operative appointments, as well as complete short questionnaires on their pain levels at specified times after surgery.

Inclusion Criteria

Able to speak and understand English

Owning a phone that can receive text messages or having internet access to complete questionnaires

DEERs eligible (eligible for healthcare within military health system)

Exclusion Criteria

I cannot take oxycodone.

My surgery was changed to an open procedure.

I cannot have a QL block done on both sides of my body.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

1 visit (in-person)

Preoperative

Participants receive a preoperative quadratus lumborum block or placebo before surgery

1 day

1 visit (in-person)

Intraoperative

Participants undergo laparoscopic hysterectomy with either QL block or local anesthetic at incision sites

1 day

1 visit (in-person)

Immediate Postoperative

Participants are monitored for opioid use and pain scores in the PACU

1 day

1 visit (in-person)

Follow-up

Participants are monitored for opioid use, pain scores, and quality of recovery at various postoperative days

4-6 weeks

Multiple visits (virtual or phone)

What Are the Treatments Tested in This Trial?

Interventions

• Quadratus Lumborum Block

Trial Overview The study tests if a QL block with liposomal bupivacaine before surgery reduces the need for narcotic medication during and after the procedure compared to just local numbing at incision sites. Patients will be randomly assigned to receive either the QL block or placebo plus local anesthetic.

How Is the Trial Designed?

Group I: Preoperative QL block with liposomal bupivacaine, intra-operative incisional injections with placebo Experimental Treatment 2 Interventions

Subjects will receive a pre-operative quadratus lumborum nerve block with liposomal bupivacaine and then an intra-operative placebo injection at each incision site with saline.

Group II: Preoperative QL block with placebo, intra-operative incisional injection with bupivacaine Active Control 2 Interventions

Subjects will undergo a sham pre-operative quadratus lumborum block procedure with saline and then an intra-operative injection of local anesthetic (0.25% bupivacaine) at each incision site.

Who Is Running the Clinical Trial?

Walter Reed National Military Medical Center

Lead Sponsor

Trials

149

Recruited

33,800+

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]

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]

The quadratus lumborum (QL) block significantly reduces opioid consumption by approximately 15.78 mg in the first 24 hours after hip surgery compared to placebo or no block, indicating its efficacy in postoperative pain management.

Patients receiving the QL block reported a reduction in pain during movement, with a pain grade decrease of 2.95 compared to those who did not receive the block, suggesting improved analgesia without affecting static pain scores.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Postoperative analgesic effectiveness of quadratus lumborum block: systematic review and meta-analysis for adult patients undergoing hip surgery. Xiong, H., Chen, X., Zhu, W., et al.[2022]

The posterior quadratus lumborum block (QLB2) significantly reduces pain scores at 6, 12, and 24 hours after abdominal surgery compared to control groups, based on a meta-analysis of 14 studies with 1001 patients.

QLB2 also decreases opioid consumption within the first 24 hours post-surgery, indicating its effectiveness in managing postoperative pain, especially for patients under general anesthesia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound-Guided Posterior Quadratus Lumborum Block for Acute Postoperative Analgesia in Adult Patients: A Meta-Analysis of Randomized Controlled Trials. Lin, C., Wang, X., Qin, C., et al.[2022]

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 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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9118859/

Postoperative analgesic effectiveness of quadratus ... Our meta-analysis indicates that QL block may be effective for analgesia in patients after hip surgery compared with placebo or no block.

2. mdpi.com mdpi.com/1648-9144/61/4/702

Efficacy of Quadratus Lumborum Block for Postoperative ... This study aimed to evaluate whether QLB reduces opioid consumption and postoperative pain in patients undergoing single-port TLH.

3. epain.org epain.org/journal/view.html?uid=1821&vmd=Full

Postoperative analgesic effects of the quadratus lumborum ... Background: This study assessed the postoperative analgesic efficacy and safety of the quadratus lumborum block (QLB) in pediatric patients.

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0952818020311284

Quadratus lumborum block for postoperative analgesia ... QLB improves post-cesarean delivery analgesia in parturients not receiving neuraxial morphine. Addition of QLB to parturients receiving neuraxial morphine has ...

5. josr-online.biomedcentral.com josr-online.biomedcentral.com/articles/10.1186/s13018-025-05968-w

The efficacy of combined lateral and anterior quadratus ... Additionally, patients who received QLB demonstrated significantly reduced levels of postoperative pain intensity both at rest and during ...

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

Efficacy of bilateral quadratus lumborum block with ... This randomized controlled trial aims to provide high-quality evidence on the efficacy and safety of liposomal bupivacaine QL blocks for post- ...

7. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/10.1111/petr.70112?af=R

Liposomal Bupivacaine in Single‐Injection Quadratus ... A quadratus lumborum block with liposomal bupivacaine provided effective and sustained pain relief for our pediatric patient undergoing kidney transplant.

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12482957/

Liposomal Bupivacaine for Quadratus Lumborum Block at the ... The findings demonstrated that administration of liposomal bupivacaine in QLB-LASL significantly reduced postoperative opioid consumption while ...

9. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1048891X25000027

Use of quadratus lumborum block in gynecologic procedures QL blocks have been shown to be effective in managing post-operative pain after gynecologic surgical procedures.