To block or not to block? That is the question (114)

Abstract

Objectives: Quadratus Lumborum (QL) blocks have gained popularity due to their more favorable safety profile compared to neuraxial techniques (e.g., epidural) in dealing with postoperative pain. They have been studied in the gynecologic population undergoing laparoscopic surgery, where pain scores were found to decrease as patients progressed through their recovery process. Yet, very little data exists studying their use in open surgery for gynecologic indications. Therefore, we aimed to determine the effect of QL blocks on postoperative opioid consumption in patients undergoing laparotomy. Methods: A retrospective study of gynecologic oncology patients undergoing surgery via laparotomy from 2018 to 2020 was performed. Demographics, postoperative pain scores, frequency, and duration of narcotic use, amount of narcotic use using Morphine Milligram Equivalents (MME), length of hospital stay, and re-admission rates for pain management were compared. Primary outcome measures include postoperative pain scores and the amount of narcotic use in MME. Results: Thirty-eight patients who met the inclusion criteria with complete data were identified as receiving QL blocks, whereas 32 patients did not receive a block during this time frame. Eighty-six percent of the blocks were placed preoperatively. Approximately 25% of patients reported their pain score on arrival to the floor as 0 out of 10. The mean pain score for patients with and without QL blocks on arrival to the floor were 2.9/10 and 3.7/10, respectively (p=0.57). Patients who received QL blocks used a mean of 18.4 MME on postoperative day 1 compared to 31.1 MME in those without blocks (p=0.008). This trend continued throughout their hospital course as the mean total MME used on hospital days 1-3 in the QL group was 49.11 compared to 80.24 in the non-QL group (p=0.009). Conclusions: Our study suggests that the use of regional QL blocks decreases the amount of narcotic pain medication (MME) used in the immediate postoperative period in patients undergoing laparotomy for gynecologic oncology indications. This is an important finding which may help decrease overall postoperative narcotic requirements given the current opioid epidemic. Future studies will focus on the impact of QL blocks on narcotic need after discharge in this patient population. Objectives: Quadratus Lumborum (QL) blocks have gained popularity due to their more favorable safety profile compared to neuraxial techniques (e.g., epidural) in dealing with postoperative pain. They have been studied in the gynecologic population undergoing laparoscopic surgery, where pain scores were found to decrease as patients progressed through their recovery process. Yet, very little data exists studying their use in open surgery for gynecologic indications. Therefore, we aimed to determine the effect of QL blocks on postoperative opioid consumption in patients undergoing laparotomy. Methods: A retrospective study of gynecologic oncology patients undergoing surgery via laparotomy from 2018 to 2020 was performed. Demographics, postoperative pain scores, frequency, and duration of narcotic use, amount of narcotic use using Morphine Milligram Equivalents (MME), length of hospital stay, and re-admission rates for pain management were compared. Primary outcome measures include postoperative pain scores and the amount of narcotic use in MME. Results: Thirty-eight patients who met the inclusion criteria with complete data were identified as receiving QL blocks, whereas 32 patients did not receive a block during this time frame. Eighty-six percent of the blocks were placed preoperatively. Approximately 25% of patients reported their pain score on arrival to the floor as 0 out of 10. The mean pain score for patients with and without QL blocks on arrival to the floor were 2.9/10 and 3.7/10, respectively (p=0.57). Patients who received QL blocks used a mean of 18.4 MME on postoperative day 1 compared to 31.1 MME in those without blocks (p=0.008). This trend continued throughout their hospital course as the mean total MME used on hospital days 1-3 in the QL group was 49.11 compared to 80.24 in the non-QL group (p=0.009). Conclusions: Our study suggests that the use of regional QL blocks decreases the amount of narcotic pain medication (MME) used in the immediate postoperative period in patients undergoing laparotomy for gynecologic oncology indications. This is an important finding which may help decrease overall postoperative narcotic requirements given the current opioid epidemic. Future studies will focus on the impact of QL blocks on narcotic need after discharge in this patient population.