Quadratus Lumborum Block in Gynecological Oncology Patients Undergoing Exploratory Laparotomy: A Retrospective Analysis

Background: Enhanced recovery after surgery (ERAS) became a widely adapted and introduced concept of multimodal pain control. However, this idea was not standardized and left room for exploration of a variety of different analgesic modalities. One such modality is the bilateral quadratus lumborum (QL) catheter block that was introduced in 2018 but is not yet been fully studied in the gynecological oncology population. Objective: Authors hypothesized that use of these catheters would help with pain management and decrease opioid consumption in the postoperative period. Methods: A retrospective chart review was conducted from 2018 to 2020 looking at patients with known gynecological malignancy who underwent an exploratory laparotomy. Groups who had the QL block were compared with those without the block. Primary outcome was opioid consumption measured in morphine milligram equivalents (MME). Secondary outcomes looked at opioid consumption analyzed by adjuvants used in the block, length until ambulation, and length of stay in the hospital. Results: Authors found that the results showed no difference on MME used on postoperative day (POD) 1 (p = 0.704), POD2 (p = 0.562), and POD3 (p =0.749, or combined over the 3 days (p = 0.597). Secondary outcomes also showed no difference: length to ambulation (p = 0.704), length of stay (p = 0.912), and QL adjuvant epinephrine (p = 1.0) and dexamethasone (p = 1.0). Results suggest that a variety of confounders may have influenced statistical significance when providers notice a clinical difference in pain control in patients who have a QL block. Conclusions: This study provides the first step in understanding pain control with blocks and paves the way for a future trial.