Does Ultrasound-Guided Quadratus Lumborum Block Improve Pain after Hysterectomy

Determine whether the quadratus lumborum block (QLB) is an effective adjunct to control postoperative pain during the first 24 hours after minimally invasive hysterectomy.

Prospective cohort observational study of patients who underwent laparoscopic or robotic hysterectomy. Patients either received a QLB or did not. Initial postoperative pain scores were recorded in the postanesthesia recovery area using a numeric rating scale. Patients were then called to collect 24-hour scores and analgesic medication usage. The primary outcome was the 3-hour pain score. Secondary analysis evaluated use of analgesic medication.

Fifty patients were enrolled in the study: 25 patients in the no-QLB cohort and 25 patients in the QLB group. The median postoperative pain scores (out of 10) were 4, 2, and 6 at 1, 3, and 24 hours in the no-QLB group. Scores were 5 (P = .541), 3 (P = .418), and 6 (P = .358), respectively, in the QLB group. A total of 11 of 25 patients at 1 hour, 8 of 25 patients at 3 hours, and 21 of 25 patients at 24 hours used analgesia postoperatively in the no-QLB group, compared to 11 of 25 patients at 1 hour (P = 1.0), 18 of 25 patients at 3 hours (P = .005), and 23 of 25 patients at 24 hours (P = .384) in the QLB group. Opioid, acetaminophen, and ibuprofen usage was not significantly different between groups.

There was no significant pain difference between the no-QLB and QLB groups. Patients who received a QLB were more likely to receive pain medication 3 hours after surgery. Thus, the use of a QLB does not appear to be a suitable adjunct for postoperative pain.