Quadratus Lumborum Block for Ventral Hernia

(VHR Trial)

Overseen By Trey A Henderson, MSc

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Tennessee Graduate School of Medicine

Disqualifiers: Infection, Coagulopathy, Neuropathy, others

Compensation: Varies

Number of Visits: 2

Duration: 1 day

70 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on pain management after surgery, so it's best to discuss your current medications with the trial team.

What data supports the effectiveness of the treatment Quadratus Lumborum Block for Ventral Hernia?

Research shows that the Quadratus Lumborum Block (QLB) is effective in reducing pain and the need for painkillers after various abdominal and hip surgeries, suggesting it may also help with pain management after ventral hernia surgery. ^{1 2 3 4 5}

Is the quadratus lumborum block generally safe for humans?

The quadratus lumborum block (QLB) has been used safely for pain management after various types of abdominal surgeries, including cesarean sections and hernia repairs, with studies indicating low pain scores and reduced opioid use post-surgery. ^{1 6 7 8 9}

How does the Quadratus Lumborum Block treatment for ventral hernia differ from other treatments?

The Quadratus Lumborum (QL) Block is a unique pain relief method that involves injecting anesthetic near the lower back muscles to numb the abdominal area, which is different from traditional pain management methods that might rely on oral medications or more invasive procedures. This technique is particularly novel for ventral hernia as it provides targeted pain relief with potentially fewer side effects compared to systemic painkillers. ^{1 3 4 10 11}

What is the purpose of this trial?

The purpose of this study is to determine whether using a QL block is better than placebo (a look-alike substance that contains no drug) in lowering the amount of opioids you need for pain relief in the first 24 hours and if it improves your recovery following a ventral hernia repair. Participants will be asked to complete a questionnaire before surgery and again at their 30-day follow up. You will also be asked to complete a pain diary 24 hours after surgery and attend a follow-up visit approximately 30 days after surgery. The following information will be collected from you or your medical record: 1. Pain medications given to you during surgery. 2. Pain medications prescribed to you after surgery, including medication name, dose, units, and frequency. 3. Pain levels during the first 24 hours after surgery. 4. Your total hospital length of stay after surgery. 5. Any complications that you may have experienced after surgery. 6. Demographic information, medical history as well as details about your hernia repair surgery.

Research Team

Kaela E Blake, MD

Principal Investigator

The University of Tennessee Graduate School of Medicine

Eligibility Criteria

This trial is for individuals undergoing open ventral hernia repair surgery. Participants should be able to complete questionnaires and a pain diary, and attend follow-up visits. Specific eligibility criteria are not provided, but typically include adults in good health without conditions that could interfere with the study.

Inclusion Criteria

Able to read and understand study procedures

Mesh placed in the retromuscular position

I am older than 18 years.

Exclusion Criteria

I have an old wound with dead tissue or an active infection.

I am allergic or have a condition that makes the trial drug/procedure unsafe for me.

I need an urgent medical procedure.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo surgery with either a Quadratus Lumborum block or placebo, and pain management is assessed for 24 hours post-surgery

1 day

1 visit (in-person)

Hospitalization

Participants are monitored for pain and recovery during their hospital stay, with pain scores recorded daily

4 days

Follow-up

Participants complete a questionnaire and attend a follow-up visit approximately 30 days after surgery

30 days

1 visit (in-person)

Treatment Details

Interventions

• Placebo
• Quadratus Lumborum (QL) Block

Trial Overview The study is testing whether a Quadratus Lumborum (QL) block reduces opioid use compared to placebo after ventral hernia repair. It also examines recovery outcomes through questionnaires, pain diaries, medication tracking, and follow-ups.

Participant Groups

Group I: Quadratus Lumborum Block Experimental Treatment 1 Intervention

The Quadratus Lumborum block will be randomly administered to half of the study patients.

Group II: Control Placebo Group 1 Intervention

The control (placebo comparator) group will undergo the same QL block procedure as the intervention arm, except saline (placebo) will be injected.

Who Is Running the Clinical Trial?

University of Tennessee Graduate School of Medicine

Lead Sponsor

Trials

17

Recruited

1,400+

Findings from Research

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 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 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 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 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 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]

The study compared different needle approaches for ultrasound-guided quadratus lumborum (QL) blocks in cadavers, finding that the alternative approach resulted in better dye spread to the transversus abdominis and transversalis fascia compared to conventional methods.

Both approaches effectively stained the middle thoracolumbar fascia, but all lateral QL blocks showed some degree of unwanted intramuscular or subcutaneous infiltration, indicating potential limitations in their application.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cadaveric Evaluation of Different Approaches for Quadratus Lumborum Blocks. Yang, HM., Park, SJ., Yoon, KB., et al.[2018]

References

1. Germany pubmed.ncbi.nlm.nih.gov

Comparison of types 2 and 3 quadratus lumborum muscle blocks : Open inguinal hernia surgery in patients with spinal anesthesia. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Quadratus lumborum block for postoperative analgesia: a systematic review and meta-analysis. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

Single injection Quadratus Lumborum block for postoperative analgesia in adult surgical population: A systematic review and meta-analysis. [2021]

4. England pubmed.ncbi.nlm.nih.gov

Anterior quadratus lumborum block analgesia for total hip arthroplasty: a randomized, controlled study. [2021]

5. England pubmed.ncbi.nlm.nih.gov

Postoperative analgesic effectiveness of quadratus lumborum block: systematic review and meta-analysis for adult patients undergoing hip surgery. [2022]

6. India pubmed.ncbi.nlm.nih.gov

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

7. England 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. [2022]

8. Japan 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. [2022]

9. Korea (South) pubmed.ncbi.nlm.nih.gov

Effect of interfascial pressure on block success during anterior quadratus lumborum block application: a prospective observational study. [2023]

10. India pubmed.ncbi.nlm.nih.gov

Analgesic sparing effect of dexamethasone with levobupivacaine in quadratus lumborum block in patients undergoing unilateral inguinal hernia repair: A prospective randomised controlled trial. [2022]

11. United States pubmed.ncbi.nlm.nih.gov

Cadaveric Evaluation of Different Approaches for Quadratus Lumborum Blocks. [2018]