A prospective observational study of the impact of the quadratus lumborum block (QLl1B) on post operative pain after laparoscopic ventral hernia repair

Abstract

Aims & Objectives: To evaluate the outcome of addition of a pre operative quadratus lumborum type 1 nerve block (QL1B) in an elective laparoscopic ventral hernia repair. Material and Methods: Prospective, observational, single-center study with patients scheduled for elective laparoscopic ventral hernia repair. After taking informed consent, patients underwent Laparoscopic IPOM (Intra Peritoneal Onlay Mesh) Repair of the hernia with mesh fixed using tackers. Preoperative QL1 Block was given to all patients after induction of anaesthesia. Pain scores at 2-, 6-, 12-, and 24-hours post-surgery were noted using a visual analogue scale (VAS). The need for rescue analgesics and total requirement of analgesics postoperatively was noted. Results: A total of 35 patients were enrolled for the study. The mean VAS score at 2-, 6-, 12- and 24-hours post-surgery was found to be 5.11, 4.14, 3.14, 2.31 respectively. Twenty nine patients (82.86 %) were managed with routine post operative analgesia (Total 4 gm. intravenous paracetamol) while six patients (17.14%) required an additional rescue analgesic. [Inj. Tramadol Hydrochloride (Total dose 100 mg.) in 5 patients and Inj. Diclofenac Sodium (Total dose 150 mg.) in 1 patient].The average time taken till the requirement of rescue analgesic was 3.83 hours. Conclusions: The QL1 Block appears to provide adequate analgesia that may last for up to 24 hours post laparoscopic IPOM repair. It should be considered as part of a multimodal postoperative pain management regimen to reduce post-operative pain and enhance recovery in patients undergoing a laparoscopic IPOM repair.

Keywords

• laparoscopic ventral hernia (ipom)
• quadratus lumborum block (qlb)
• vas score
• post-operative pain