Anterior Quadratus Lumborum Block as a Component of Multimodal Analgesia for Abdominal Hysterectomies

A Randomized Controlled Double-blinded Trial Evaluating the Efficacy of the Anterior Quadratus Lumborum Block as a Component of Multimodal Perioperative Analgesia for Abdominal Hysterectomies

The main goal of this randomised double-blinded controlled trial is to assess whether adding anterior quadratus lumborum block preoperatively can reduce intraoperative and postoperative opioid consumption, reduce pain after abdominal hysterectomy and improve quality of recovery after anesthesia. The study hypothesis is that anterior QL block bilaterally before the start of a surgery has no impact on perioperative pain relief, can't reduce the need in opioids and will not improve quality of recovery after anesthesia.

All patients will undergo general anesthesia with tracheal intubation and mechanical ventilation. Patients will be randomized into two groups. In addition to general anesthesia and multimodal analgesia with parenteral medication II (QL) group will receive also anterior quadratus lumborum block as a regional component.

Study Overview

• Status: Completed
• Conditions: Uterine Neoplasms; Uterine Diseases; Uterine Fibroids; Uterine Bleeding
• Intervention / Treatment: Drug: Parenteral administration of analgesics; Procedure: General Anesthesia (GA); Procedure: ANTERİOR QUADRATUS LUMBORUM BLOCK

Detailed Description

Primary outcomes : intraoperative fentanyl consumption, daily requirement of morphine and pain level (with visual analogue scale - VAS) after surgery. Secondary outcomes: quality of recovery after anesthesia (with QoR-15 questionnaire), heart rate perioperatively, mean arterial pressure perioperatively, incidence of postoperative nausea.

Thromboprophylaxis will be administered based on the risk of thromboembolic complications for all patients. In the operative room all patients will receive ondansetron, dexamethasone and tranexamic acid. Patients will be told that they will receive multimodal analgesia but they won't know if they get a regional component (quadratus lumborum block). The randomisation will take place in the operative room. After general anesthesia induction and endotracheal intubation attending anesthesiologist will leave the operative room and anesthesiologist-resident will perform randomization and QL-block or won't perform QL-block. Thus participants and attending anesthesiologist won't know the randomisation result. In our study attending anaesthesiologist will be the researcher who will collect and analyse data. After the intubation patients of the control group will receive acetaminophen 1000 mg, dexketoprofen 50 mg before incision and MgSO4 1250 mg with ongoing continuous infusion of MgSO4 2500 mg per hour. In addition to these analgesia regimen patients in the II (QL) group will receive bilateral ultrasound-navigated anterior quadratus lumborum block before the start of the surgery. The investigators will use a convex low-frequency transducer with a frequency of 1.5-5 Mhz (General Electric Logiq e ultrasound machine). The block will be performed in the patient's spine position. Investigators choose anterior approach hypothesizing its superiority over other approaches to quadratus lumborum block. After proper visualization and obtaining an adequate sonographic image, the 22g needle will be inserted through the lateral abdominal wall and will be advanced through the skin, subcutaneous fat tissue, external oblique muscle, internal oblique muscle, aponeurosis of the transverse abdominis muscle, then it will be advanced through the quadratus lumborum muscle and operator will reach thoracolumbar fascia, between the quadratus lumborum muscle and the psoas major muscle. In this localization anesthesiologist-resident will inject a local anesthetic. Operator will use 20 ml of 0,25% bupivacaine with 4 mg of dexamethasone as adjuvant for one side, all blocks will be performed bilaterally only. General anaesthesia will be maintained by continuous propofol infusion with target effect site concentration 3-3,5 mcg/ml, atracurium infusion with target effect site concentration 900 ng/ml and bolus fentanyl injections to maintain target effect site concentration 2-4 ng/ml. All target concentrations will be calculated via ITIVA version 6.3.2 software. Attending anesthesiologist will modify the dosage of anesthetic drugs, particularly fentanyl, reducing them if necessary. At postoperative stage for patients of both groups investigators plan to administer multimodal analgesia: dexketoprofen (150 mg/day), acetaminophene (4000 mg/day). In addition, in the case of severe pain - morphine will be added (5-20 mg/day).

Mechanical ventilation will be performed in pressure-regulated volume control ventilation mode counting tidal volume 6 ml/kg (Getinge Flow-e anesthesia machine). Intraoperatively attending anesthesiologist will count the fentanyl consumption considering that the length of the surgeries will not have significant differences.

At the end of the surgery investigators will count total amount of administered fentanyl, evaluate heart rate and mean arterial pressure.

After the end of the surgeries patients will be extubated and transferred to the postoperative ward. After the surgery investigators are planning to evaluate morphine consumption, level of pain according to the visual analogue scale (VAS), quality of recovery after anesthesia (with QoR-15 questionnaire), heart rate, mean arterial pressure, incidences of nausea.

• Study Type: Interventional
• Enrollment (Actual): 56
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Ukraine
  • Rivne Oblast
    • Rivne, Rivne Oblast, Ukraine, 33007
      • Yuri Semenyuk Rivne regional cinical hospital

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• patients with ASA status I-II
• patients with symptomatic fibroids
• patients scheduled for abdominl hysterectomy

Exclusion Criteria:

• refusal to participate in the study at any of its stages
• ASA class ≥ III
• body mass index > 40 kg/m2
• use of opiate receptor agonists/antagonists before surgery
• uncontrolled hypertension

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Group I (control); Patients in Group I will undergo general anesthesia with tracheal intubation and mechanical ventilation. Analgesia regimen will include parenteral medication.	Drug: Parenteral administration of analgesics; Intravenous opioids or NSAIDs used perioperatively.; Procedure: General Anesthesia (GA); Standard general anesthesia per continious 1% propofol infusion and propofol bolus administration, atracurium and fentanyl administration.
Experimental: Group II (QL); Patients in Group II (QL) will undergo general anesthesia with tracheal intubation and mechanical ventilation. Analgesia regimen will include parenteral medication and anterior quadratus lumborum block as a regional component.	Drug: Parenteral administration of analgesics; Intravenous opioids or NSAIDs used perioperatively.; Procedure: General Anesthesia (GA); Standard general anesthesia per continious 1% propofol infusion and propofol bolus administration, atracurium and fentanyl administration.; Procedure: ANTERİOR QUADRATUS LUMBORUM BLOCK; Ultrasound-guided anterior QL block performed preoperatively

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain level after surgery	It will be tested using visual analogue scale (VAS)	It will be checked at the folowing stages of the study: 30 minutes (m30) 6 hours (h6), 12 hours (h12), 24 hours (h24), 48 hours (h48) after the end of the surgery.
Requirement of morphine for 24 hours	The investigators will count a dose of morphine administered for patients of both groups postoperatively	24 hours (h24), 48 hours (h48) after the surgery
Intraoperative fentanyl consumption	The investigators will compare fentanyl consumption between two groups, considering that the duration of surgeries differences won't be statistically significant.	Intraoperative stage, at the end of the surgery (h0)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of recovery after anesthesia	The investigators will measure it using QoR-15 questionnaire	The investigators will test it in 24 hours after the end of the surgery (h24)
Postoperative nausea	The investigators will define the incidents of nausea in both groups after the surgery	At 30 minutes (m30), 6 hours (h6), 12 hours (h12), 24 hours (h24) after the end of the surgery
Perioperative heart rate	The investigators will evaluate heart rate during the surgery and after it will be finished.	The investigators will evaluate parameters at intraoperative stage (h0), 30 minutes (m30), 6 hours (h6), 12 hours (h12), 24 hours (h24), 48 hours (h48) after the surgery.
Mean arterial pressure perioperatively	The investigators will evaluate mean arterial pressure during the surgery and after it will be finished.	The investigators will evaluate the parameters at intraoperative stage (h0), 30 minutes (m30), 6 hours (h6), 12 hours (h12), 24 hours (h24), 48 hours (h48) after the surgery.

Collaborators and Investigators

• Sponsor: Yuri Semenyuk Rivne Regional Clinical Hospital
• Collaborators: Danylo Halytsky Lviv National Medical University
• Investigators: Study Chair: Olha Filyk, Professor, Danylo Halytsky Lviv National Medical University

Study record dates

Study Major Dates

• Study Start (Actual): July 7, 2025
• Primary Completion (Actual): December 8, 2025
• Study Completion (Actual): December 11, 2025

Study Registration Dates

• First Submitted: May 29, 2025
• First Submitted That Met QC Criteria: June 23, 2025
• First Posted (Actual): July 2, 2025

Study Record Updates

• Last Update Posted (Actual): December 16, 2025
• Last Update Submitted That Met QC Criteria: December 14, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: Chronic pain; Pain management; Postoperative nausea and vomiting; Acute pain; Quality of recovery; Regional anesthesia; Opioid consumption; General anesthesia; Multimodal analgesia; Pain scores; Abdominal hysterectomy; Quadratus lumborum block; Blended anesthesia; Hemodynamics after surgery
• Additional Relevant MeSH Terms: Urogenital Diseases; Genital Diseases; Pain; Neurologic Manifestations; Nervous System Diseases; Postoperative Complications; Pathologic Processes; Urogenital Neoplasms; Neoplasms by Site; Neoplasms; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Signs and Symptoms, Digestive; Neoplasms by Histologic Type; Neurobehavioral Manifestations; Genital Diseases, Female; Hemorrhage; Genital Neoplasms, Female; Neoplasms, Connective and Soft Tissue; Neoplasms, Muscle Tissue; Perceptual Disorders; Vomiting; Nausea; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Uterine Hemorrhage; Chronic Pain; Acute Pain; Postoperative Nausea and Vomiting; Uterine Neoplasms; Uterine Diseases; Agnosia; Leiomyoma; Anesthesia and Analgesia; Anesthesia; Anesthesia, General
• Other Study ID Numbers: 7-A/2812

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: IPD used in the results publication will be shared.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No