Obstetrics & Gynecology · Medical Literature
Clinical observation of opioid-sparing anesthesia combined with QLB in patients undergoing gynecological laparoscopic surgery: A randomized controlled trial.
Abstract
Laparoscopic surgery has become the mainstream approach for gynecological procedures. However, postoperative pain, particularly visceral pain, remains a major obstacle to achieving enhanced recovery after surgery. Therefore, this study aimed to observe the clinical effects of opioid-sparing anesthesia combined with a quadratus lumborum block (QLB) in patients undergoing gynecological laparoscopic surgery to provide a reference for clinical practice. A total of 80 female patients (aged 18 to 65 years, body mass index 18 to 28 kg/m2, American Society of Anesthesiologists I-II) scheduled for elective gynecological laparoscopic surgery under general anesthesia were enrolled and randomly assigned to 2 groups (n = 40 each): the control group (Group C) and the treatment group (Group T). All patients received general anesthesia. In Group T, a bilateral QLB was additionally performed under ultrasound guidance after the induction of general anesthesia. The following parameters were recorded for both groups: general demographic data and perioperative parameters; total intraoperative remifentanil consumption; postoperative analgesic pump consumption at 0 to 24 hours and 24 to 48 hours; the number of effective presses and total presses of the analgesic pump during 0 to 24 hours and 24 to 48 hours postoperatively; numerical rating scale (NRS) scores at rest and during movement at 2 hours, 6 hours, 12 hours, 24 hours, and 48 hours postoperatively; the rescue analgesia rate within 48 hours postoperatively; and the incidence of adverse reactions (hypotension, respiratory depression, postoperative nausea and vomiting [PONV], somnolence). Compared with Group C, patients in Group T had significantly reduced the following parameters: total intraoperative remifentanil consumption (P < .05); analgesic pump consumption at 0 to 24 hours and 24 to 48 hours postoperatively (P < .05); the number of effective presses and total presses of the analgesic pump during 0 to 24 hours and 24 to 48 hours postoperatively (P < .05); resting NRS scores at 12 hours, 24 hours, and 48 hours postoperatively (P < .05); and movement NRS scores at 6 hours, 12 hours, 24 hours, and 48 hours postoperatively (P < .05). Furthermore, the rescue analgesia rate within 48 hours postoperatively was significantly lower in Group T compared to Group C (P < .05). Regarding adverse reactions, the incidence of PONV in Group T was considerably lower than that in Group C (P < .05). For gynecological patients undergoing laparoscopic surgery, the application of opioid-sparing anesthesia combined with a QLB provides effective analgesia, reduces intraoperative opioid consumption, prolongs the duration of postoperative analgesia, lowers the incidence of PONV, and promotes enhanced postoperative recovery.
Clinical relevance
Postoperative pain — especially visceral pain — remains a critical barrier to enhanced recovery after surgery (ERAS) in gynecological laparoscopy, a procedure that has become the dominant surgical approach in the specialty. This RCT addresses the evidence gap surrounding multimodal, opioid-sparing strategies by evaluating the quadratus lumborum block (QLB) as an adjunct to general anesthesia in an ASA I–II female population aged 18–65. Given the well-documented adverse effect profile of opioids (PONV, somnolence, respiratory depression) and the push toward ERAS protocols, clinicians need high-quality data on regional anesthesia adjuncts that can meaningfully reduce perioperative opioid burden.
Key findings
1. Intraoperative opioid consumption: Total remifentanil consumption was significantly lower in the QLB group (Group T) versus control (Group C) (P < .05); exact means/SDs not reported in the abstract. 2. Postoperative analgesic pump consumption: Both 0–24-hour and 24–48-hour postoperative analgesic pump consumption were significantly reduced in Group T versus Group C (P < .05 for both intervals). 3. Analgesic pump press frequency: Both the number of effective presses and total presses of the patient-controlled analgesia pump were significantly fewer in Group T during both 0–24 hours and 24–48 hours postoperatively (P < .05 for all comparisons). 4. Resting NRS pain scores: Group T demonstrated significantly lower resting NRS scores at 12, 24, and 48 hours postoperatively compared to Group C (P < .05); scores at 2 and 6 hours did not reach significance at rest. 5. Movement NRS pain scores: Group T achieved significantly lower movement-associated NRS scores at 6, 12, 24, and 48 hours postoperatively (P < .05), indicating earlier and sustained dynamic pain relief. 6. Rescue analgesia and PONV: The rescue analgesia rate within 48 hours postoperatively was significantly lower in Group T (P < .05); additionally, the incidence of PONV was significantly reduced in Group T versus Group C (P < .05), with no significant between-group differences reported for hypotension, respiratory depression, or somnolence. Note: Absolute rates, effect sizes, confidence intervals, and NNT/NNH were not provided in the abstract.
Practice implications
For ASA I–II female patients aged 18–65 undergoing elective gynecological laparoscopic surgery under general anesthesia, incorporating a bilateral ultrasound-guided QLB immediately after induction should be considered as part of an opioid-sparing multimodal analgesia protocol, given its demonstrated reduction in intraoperative remifentanil use, prolonged postoperative analgesia across the full 48-hour window, and lower PONV incidence. Anesthesiologists should ensure competency in ultrasound-guided QLB technique and confirm appropriate patient selection (BMI 18–28 kg/m², no contraindications to regional block) before adopting this approach. Integration of this strategy into institutional ERAS pathways for gynecological laparoscopy is warranted, though clinicians should note the absence of reported absolute effect sizes and confidence intervals in the available abstract, and await full-text data or confirmatory trials before definitive protocol-level implementation.