Retrospective Analysis of Different Quadratus Lumborum Block Techniques on Recovery Quality and Analgesic Consumption in Radical Cystectomy Patients (QLB-CYS)

This retrospective observational study evaluates the effects of different Quadratus Lumborum Block (QLB) techniques on postoperative recovery and total opioid consumption in patients undergoing radical cystectomy under general anesthesia. The study will analyze intraoperative and postoperative patient records from October 15, 2023, to October 15, 2024, at Tekirdağ Namık Kemal University Hospital.

Patients who received anterior or posterior QLB for postoperative analgesia will be included. Data collection will involve demographic information, total opioid consumption (morphine milligram equivalents), recovery quality scores (QoR-15), postoperative pain scores (Visual Analog Scale, VAS), time to first rescue analgesic administration, frequency of rescue analgesic use, and incidence of postoperative nausea and vomiting (PONV).

The retrospective analysis will compare the two QLB techniques to determine if there is a significant difference in postoperative opioid consumption and recovery quality. Statistical methods will be used to assess pain scores over time, opioid consumption, and overall recovery quality.

Study Overview

• Status: Completed
• Conditions: Bladder Cancer; Postoperative Pain Management; Opioid Consumption; Recovery Quality
• Intervention / Treatment: Procedure: Anterior Quadratus Lumborum Block (QLB); Procedure: Posterior Quadratus Lumborum Block (QLB)

Detailed Description

Postoperative pain management plays a crucial role in optimizing recovery after radical cystectomy, as inadequate pain control can lead to increased opioid consumption and delayed rehabilitation. This retrospective observational study examines the effects of two different Quadratus Lumborum Block (QLB) techniques-anterior and posterior approaches-on postoperative pain and opioid consumption.

The study includes patients who underwent radical cystectomy under general anesthesia at Tekirdağ Namık Kemal University Hospital between October 15, 2023, and October 15, 2024. The primary focus is to compare total opioid consumption (morphine milligram equivalents) within the first 24 hours after surgery between the two groups.

Secondary outcomes include:

• Pain scores at multiple time points (0, 2, 6, 12, 24 hours), measured using the Visual Analog Scale (VAS)
• Postoperative recovery quality scores (QoR-15)
• Time to first rescue analgesic administration
• Frequency of rescue analgesic use
• Incidence of postoperative nausea and vomiting (PONV)

Data will be collected from intraoperative and postoperative patient records. Statistical analysis will compare anterior vs. posterior QLB techniques, evaluating differences in postoperative opioid consumption, pain relief efficacy, and recovery quality (QoR-15 scores).

This study aims to provide evidence-based insights into the use of regional anesthesia techniques for radical cystectomy patients, supporting the refinement of multimodal analgesia strategies to optimize pain management and minimize opioid exposure.

• Study Type: Observational
• Enrollment (Actual): 32

Contacts and Locations

Study Locations

• Turkey
  • Tekirdağ, Turkey
    • Tekirdağ Namık Kemal University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

This study includes adult patients (18-65 years old) who underwent radical cystectomy under general anesthesia at Tekirdağ Namık Kemal University Hospital between October 15, 2023, and October 15, 2024. Patients were retrospectively selected based on the administration of anterior or posterior Quadratus Lumborum Block (QLB) for postoperative analgesia. Patients with complete medical records were included, while those with missing data, coagulopathy, chronic opioid use, or unplanned open surgery conversion were excluded.

Description

Inclusion Criteria:

1. Patients who underwent radical cystectomy under general anesthesia between October 15, 2023, and October 15, 2024.
2. Patients who received anterior or posterior quadratus lumborum block (QLB) for postoperative analgesia.
3. Age: 18-65 years.
4. ASA Physical Status Classification: I-III.
5. BMI < 35 kg/m².
6. Complete medical records available for retrospective review.

Exclusion Criteria:

1. Patients who received a different postoperative analgesia technique (e.g., epidural, TAP block).
2. Incomplete or missing medical records.
3. Psychiatric disorders that could affect pain perception and reporting.
4. Coagulopathy or bleeding disorders.
5. Hepatic or renal failure.
6. Chronic opioid use before surgery.
7. Patients who required unplanned conversion to open surgery.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Anterior QLB Group; Patients who underwent radical cystectomy under general anesthesia and received anterior quadratus lumborum block (QLB) for postoperative analgesia.	Procedure: Anterior Quadratus Lumborum Block (QLB); A regional anesthesia technique where local anesthetic is injected anterior to the quadratus lumborum muscle under ultrasound guidance for postoperative pain management.
Posterior QLB Group; Patients who underwent radical cystectomy under general anesthesia and received posterior quadratus lumborum block (QLB) for postoperative analgesia.	Procedure: Posterior Quadratus Lumborum Block (QLB); A regional anesthesia technique where local anesthetic is injected posterior to the quadratus lumborum muscle under ultrasound guidance for postoperative pain management.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total Opioid Consumption (Morphine Milligram Equivalents) in the First 24 Hours	The total amount of opioids (converted to morphine milligram equivalents) administered postoperatively within the first 24 hours following radical cystectomy. Continuous variable (mg of morphine equivalent)	0-24 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Scores Using Visual Analog Scale (VAS) at Multiple Time Points	Postoperative pain levels measured using the Visual Analog Scale (VAS) at predetermined time points: 0, 2, 6, 12, and 24 hours. Ordinal variable (0-10 VAS score, higher scores indicate more pain)	0, 2, 6, 12, and 24 hours postoperatively
Postoperative Recovery Quality (QoR-15 Score)	Recovery quality assessed using the QoR-15 questionnaire, a validated patient-reported outcome measure. Continuous variable (QoR-15 total score, higher scores indicate better recovery quality)	24 hours postoperatively
Time to First Rescue Analgesic Administration	The duration (in minutes) from the end of surgery until the first administration of rescue analgesia. Continuous variable (minutes)	0-24 hours postoperatively
Frequency of Rescue Analgesic Use	The number of times rescue analgesics were administered during the first 24 hours postoperatively. Count variable (number of doses)	0-24 hours postoperatively
Incidence of Postoperative Nausea and Vomiting (PONV)	The proportion of patients who experience postoperative nausea and vomiting within the first 24 hours. Binary variable (Yes/No; presence of PONV)	0-24 hours postoperatively

Collaborators and Investigators

• Sponsor: Namik Kemal University

Publications and helpful links

General Publications

• Korgvee A, Veskimae E, Huhtala H, Koskinen H, Tammela T, Junttila E, Kalliomaki ML. Posterior quadratus lumborum block versus epidural analgesia for postoperative pain management after open radical cystectomy: A randomized clinical trial. Acta Anaesthesiol Scand. 2023 Mar;67(3):347-355. doi: 10.1111/aas.14188. Epub 2023 Jan 3.

Study record dates

Study Major Dates

• Study Start (Actual): October 15, 2023
• Primary Completion (Actual): October 15, 2024
• Study Completion (Actual): December 15, 2024

Study Registration Dates

• First Submitted: February 24, 2025
• First Submitted That Met QC Criteria: February 24, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 24, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Urogenital Diseases; Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Urogenital Neoplasms; Neoplasms by Site; Neoplasms; Male Urogenital Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urologic Neoplasms; Urinary Bladder Diseases; Pain, Postoperative; Urinary Bladder Neoplasms
• Other Study ID Numbers: 2024.297.11.04

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No