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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether a Quadratus Lumborum (QL) block—a type of anesthesia that numbs part of the abdomen—can reduce opioid use after ventral hernia surgery and improve recovery. Participants will receive either the QL block or a placebo (a non-active substance) to determine which is more effective. The trial seeks individuals undergoing planned ventral hernia repairs with mesh placed in a specific way. Participants will track their pain and recovery to help researchers assess the QL block's effectiveness. As an unphased trial, this study allows participants to contribute to important research that could enhance post-surgical recovery for many 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. It focuses on pain management after surgery, so it's best to discuss your current medications with the trial team.

What prior data suggests that the Quadratus Lumborum Block is safe for ventral hernia repair?

Research has shown that the Quadratus Lumborum (QL) block is generally safe for patients. Studies indicate it reduces pain after surgeries such as hernia repairs. No complications have been reported with the QL block for pain relief, and its effects last about 24 to 48 hours. One study found it to be a safe and effective method for reducing post-surgery pain. This suggests that the QL block is well-tolerated, making it a promising option for managing pain after surgery. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Quadratus Lumborum (QL) Block for ventral hernia pain management because it offers a unique approach to pain relief. Unlike standard treatments like oral pain medications or epidural analgesia, the QL Block involves a targeted injection of anesthetic near the quadratus lumborum muscle, which may provide more effective and longer-lasting pain relief. This localized approach could reduce the need for systemic painkillers, minimizing side effects and potentially enhancing recovery. This innovative method of targeting the nerve pathways directly associated with hernia-related pain is what sets it apart from traditional options.

What evidence suggests that the Quadratus Lumborum Block is effective for reducing opioid use after ventral hernia repair?

Research has shown that the Quadratus Lumborum (QL) block can reduce pain and the need for opioid painkillers after surgery. In this trial, some participants will receive the QL block, which studies have found to provide better pain relief than a placebo for patients undergoing ventral hernia repairs. In another study with hip surgery patients, those who received a QL block reported less pain and required fewer opioids. This block numbs a specific area of the lower back to ease surgical pain. Overall, the QL block is considered a promising option for managing post-surgical discomfort. ^{1 2 5 6 7}

Who Is on the Research Team?

Kaela E Blake, MD

Principal Investigator

The University of Tennessee Graduate School of Medicine

Are You a Good Fit for This Trial?

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 for a Trial Participant

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)

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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 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]

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]

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]

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]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40072619/

Outcomes of quadratus lumborum blocks for pain control ... This is the first study to report on post-operative opioid consumption in patients receiving a quadratus lumborum block prior to open ventral hernia repair.

2. cdn.clinicaltrials.gov cdn.clinicaltrials.gov/large-docs/35/NCT06953635/Prot_SAP_000.pdf

PI: Kaela E. Blake MD Title: Quadratus Lumborum Blocks ... ... ventral hernia repair, a QL block is a superior analgesic compared to placebo block. It is possible that the QL block will prove to be less.

3. sciencedirect.com sciencedirect.com/science/article/pii/S0104001425000983

Comparison of three quadratus lumborum block ... Discussion. Our findings indicate that the anterior QL block is superior to the lateral and posterior approaches in terms of postoperative analgesic outcomes.

4. withpower.com withpower.com/trial/quadratus-lumborum-block-for-ventral-hernia-f8a15

Quadratus Lumborum Block for Ventral Hernia (VHR Trial) In a study of 80 patients undergoing total hip arthroplasty, the quadratus lumborum (QL) block significantly reduced pain scores and opioid consumption for up ...

5. bmcanesthesiol.biomedcentral.com bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-019-0862-z

Ultrasound-guided quadratus lumborum block for ... Quadrates Lumborum Block (QLB) has been described to provide adequate postoperative analgesia after abdominal surgery.

6. nature.com nature.com/articles/s41598-020-65604-x

Quadratus Lumborum Block As A Single Anesthetic ... QL block is a safe and effective option for patients undergoing TEP inguinal hernia repair, given the observed reduction in early postoperative pain.

7. frontiersin.org frontiersin.org/journals/medicine/articles/10.3389/fmed.2018.00044/full

A Review of the Quadratus Lumborum Block and ERAS The block effect lasts 24–48 h and until now no complications have been described during the block performance. QLB is safe and has found its place in ...