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Licensed Unlicensed Requires Authentication Published by De Gruyter May 21, 2019

Quadratus lumborum block for postoperative analgesia after full abdominoplasty: a randomized controlled trial

  • Thor W. Bjelland , Thomas G.R. Yates , Morten W. Fagerland , Jan K. Frøyen , Karl R. Lysebråten EMAIL logo and Ulrich J. Spreng


Background and aims

The quadratus lumborum block (QLB) provides regional analgesia of the anterior abdominal wall, theoretically matching the postoperative pain after postbariatric standard full abdominoplasty. We investigated the effectiveness of a QLB as an addition to the current multimodal analgesia regimen in postbariatric patients treated with standard full abdominoplasty.


Randomized, placebo-controlled, triple blinded study (n = 50). All patients received perioperative paracetamol and intraoperative local anesthetic infiltration. QLB was administered bilaterally before induction of general anesthesia with 2 × 20 mL of either ropivacaine 3.75 mg/mL (n = 25) or placebo (saline 9 mg/mL) (n = 25). Patients received intravenous patient controlled opioid analgesia postoperatively. The primary endpoint was opioid use during the first 24 postoperative hours. Secondary endpoints were acute and chronic postoperative pain, postoperative nausea and vomiting, and other side effects.


Patient characteristics were similar between groups. The primary endpoint in morphine equivalent units was similar between groups during the first 24 h with mean (SD) of 26 (25) vs. 33 (33) mg (p = 0.44) in the ropivacaine and placebo group, respectively. The observed effect was smaller, and SD larger than assumed in the sample size estimation. Linear mixed effects modeling indicated a minimal inter-group difference. No differences were found for secondary endpoints.


The QLB did not provide significant additional benefit in terms of reduced opioid requirements or secondary endpoints when administered as part of a multimodal pain regimen to postbariatric patients undergoing standard full abdominoplasty. A minimal difference of little clinical importance the first 12 postoperative hours may have been missed.


Including the QLB in the current multimodal pain regimen cannot be recommended based on these findings. The study does not preclude QLB use in individual cases where the multimodal regimen is inadequate or contraindicated. The effectiveness of the QLB for supraumbilical pain remains undocumented.

Corresponding author: Karl R. Lysebråten, MD, Department of Anesthesia, Intensive Care and Emergencies, Baerum Hospital, Sogneprest Munthe-kaas vei, Vestre Viken HT, 1346 Sandvika, Norway, Phone: +47 67809326


Pain nurses Helena Blom and Bjørg Farup (patient follow up, 24-h recordings); Research nurse Elisabet Anderson (patient inclusion and data verification/plotting); The nurse anesthetists at Bærum hospital (perioperative recordings); The post-anesthesia care unit nurses at Bærum hospital (postoperative recordings); The nurses at the ward for gynecology and plastic surgery at Bærum hospital, with a special thanks to Kersti Gerner (12 and 24-h recordings); Torill M. Skudal, Jarle B. Haugland and Cecilie S. Lootsma at the hospital pharmacy for providing blinded study drugs.

  1. Authors’ statements

  2. Research funding: The study was funded by a grant from Vestre Viken Hospital Trust, Norway.

  3. Conflict of interest: The authors have no conflicts of interest.

  4. Informed consent: Informed consent has been obtained from all individuals included in this study.

  5. Ethical approval: The research related to human use complies with all the relevant national regulations, institutional policies and was performed in accordance with the tenets of the Helsinki Declaration, and was approved by The South East Regional Ethics Committee, Postboks 1130, Blindern, 0318 Oslo, Norway, under the protocol number 2016/1307, on Oct 10, 2016.


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Supplementary Material

The online version of this article offers supplementary material (

Received: 2019-01-14
Revised: 2019-04-07
Accepted: 2019-04-15
Published Online: 2019-05-21
Published in Print: 2019-10-25

©2019 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.

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