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Postoperative PainPhase 4NCT06709716

Impact of Preoperative Quadratus Lumborum Block on Postoperative Opioid Consumption After Laparoscopic Hysterectomy

A Phase 4 study testing Quadratus Lumborum Block (QLB), Quadratus lumborum block and Local Anesthetic Solution in people with Postoperative Pain and Laparoscopic Hysterectomy, run by Walter Reed National Military Medical Center at 1 site in United States.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

The goal of this clinical trial is to learn if preoperative nerve block (quadratus lumborum [QL] block) works to improve pain control during and after laparoscopic hysterectomy. The main questions it aims to answer are: Does QL block decrease the amount of narcotic medication needed during surgery? Does QL block… Read more about this study

Who is it for?
Ages 18 years and older, women only
What is being tested?
Quadratus Lumborum Block (QLB), Quadratus lumborum block and Local Anesthetic Solution
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
76 participants
Where
1 siteUnited States
Study dates
1 Dec 2024to Feb 2026
Phase
Phase 4
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 18 years or older
  • scheduled to undergo laparoscopic hysterectomy
  • able to speak and understand English
  • DEERs eligible (eligible for healthcare within military heath system)
  • Owning a phone that can receive text messages or having internet access to complete questionnaires

Who cannot join

  • pre-operative opioid use
  • pre-operative pain management clinic patient
  • planned concomitant prolapse or incontinence procedure
  • planned concomitant non-gynecologic abdominal procedure (i.e. hernia repair)
  • inability to receive liposomal or non-liposomal bupivacaine
  • inability to receive non-steroidal anti-inflammatory drugs (NSAIDs)
Show all 11Show fewer
  • inability to receive acetaminophen
  • inability to receive oxycodone
  • QL block not able to be performed bilaterally
  • planned or performed mini-laparotomy (incision greater than 2cm)
  • case converted to laparotomy

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

United States1 site
  • Walter Reed National Military Medical Center

    Bethesda, Maryland, 20889

    Kathryn A Edmonds, MD, 301-400-2140, kathryn.a.edmonds2.mil@health.mil

    Candice E Jones-Cox, MD, 301-319-8866, candice.e.jones-cox.civ@health.mil

Other trials in United States

About this study

Official title: Impact of Preoperative Quadratus Lumborum Block on Postoperative Opioid Consumption After Laparoscopic Hysterectomy: a Double-blinded Randomized Controlled Trial

The goal of this clinical trial is to learn if preoperative nerve block (quadratus lumborum [QL] block) works to improve pain control during and after laparoscopic hysterectomy. The main questions it aims to answer are:

Does QL block decrease the amount of narcotic medication needed during surgery? Does QL block decrease the amount of narcotic medication needed after surgery?

Read more

Researchers will compare QL block to local injection of a numbing medication at each incision site (the current standard practice) to see if QL block works to decrease surgical pain.

Participants will be randomly assigned to receive one of the two following interventions:

  1. QL block before surgery with a long-acting numbing medicine (liposomal bupivacaine) and then injection of placebo (saline) at each incision site in the operating room.
  2. QL block before surgery with placebo (saline) and then injection of local numbing medicine (bupivacaine) at each incision site in the operating room.

Participants will also:

  • Visit the clinic/hospital for a pre-operative appointment, the surgical procedure, and a 4-6 week post-operative appointment (all standard visits even if not participating in research)
  • Complete a questionnaire electronically, or by phone, that takes <10 minutes at the pre-operative appointment and on postoperative days 1, 3, 5, 14, and 4-6 weeks.
Read the detailed description

Context: (Background) Given the opioid epidemic, gynecologic enhanced recovery after surgery (ERAS) pathways have been developed to reduce post-operative narcotic use through multimodal pain regimens and pre-surgical anesthetic adjuncts. While local anesthetic injection at trocar incision sites has long been accepted as a standard practice to decrease postoperative pain in laparoscopic surgery, including hysterectomy, regional nerve blockades are emerging as a promising adjunct technique for management of perioperative pain. At this time, the data evaluating the effect of regional nerve blocks on postoperative pain after laparoscopic hysterectomy are limited, thus the investigators designed the following study.

Objectives: (primary and secondary objectives) To determine the impact of preoperative quadratus lumborum (QL) block on postoperative pain following laparoscopic hysterectomy. The primary outcomes will be intraoperative and immediate post-operative opioid use, measured in morphine equivalent dose (MED). Secondary outcomes will include pain scores, functional impact of pain, perception of pain and recovery, voiding dysfunction, time to discharge, nausea/vomiting, emergency room visits, readmission, and reoperation rates.

Study Design:

This study is designed as a prospective, double-blinded, randomized controlled trial comparing opioid use in women undergoing laparoscopic hysterectomy who receive a preoperative QL block to local injection of bupivacaine (common local anesthestic).

Setting/Participants:

The study will take place at a single academic medical center that is a referral center within the military health system. Eligible patients will include adult women undergoing laparoscopic hysterectomy, including robot-assisted, that are not pain management clinic patients and don't use opioids preoperatively. Patients who have contraindications to the study protocol will be ineligible. A total of 76 patients will be enrolled with 38 in each arm.

Study Interventions and Measures:

Study arm patients will receive a preoperative bilateral QL block with an admixture of liposomal bupivacaine and 0.25% bupivacaine then an intraoperative placebo injection at each incision site with 0.9% saline. Control arm patients will receive a preoperative bilateral placebo QL block with 0.9% saline then an intraoperative injection of 0.25% bupivacaine at each incision site. Pre, intra, and postoperative care will be standardized for all study patients using the Gynecologic ERAS protocol and standard hospital perioperative procedures/protocols.

Opioid use will be measured in morphine equivalent doses (MEDs) at the intraoperative and immediate postoperative (prior to discharge) timepoints, as well as, at postoperative days 1, 3, 5, 14, and 4-6 weeks. Pain scores and impact of pain on functional status will be assessed using the DVPRS and Quality of Recovery-15 survey at these timepoints.

Being tested
Quadratus Lumborum Block (QLB), Quadratus lumborum block, Local Anesthetic Solution
Keywords
postoperative pain, quadratus lumborum block, laparoscopic hysterectomy
Medical subject headings
Pain, Postoperative

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Quadratus Lumborum Block (QLB)Drug

    Also called liposomal bupivacaine

    Pre-operative quadratus lumborum block with liposomal bupivacaine

  • Quadratus lumborum blockDrug

    Also called saline

    Pre-operative quadratus lumborum block with saline

  • Local Anesthetic SolutionDrug

    Also called bupivacaine

    Intraoperative injection of 0.25% bupivacaine at each incision site

  • Local Anesthetic SolutionDrug

    Also called Saline

    Intraoperative injection of saline at each incision site.

Study groups in NCT06709716
Study groupRoleWhat they receive
Preoperative QL block with liposomal bupivacaine, intra-operative incisional injections with placeboExperimentalSubjects will receive a pre-operative quadratus lumborum nerve block with liposomal bupivacaine and then an intra-operative placebo injection at each incision site with saline.
Receives: Drug: Quadratus Lumborum Block (QLB); Drug: Local Anesthetic Solution
Preoperative QL block with placebo, intra-operative incisional injection with bupivacaineActive comparatorSubjects will undergo a sham pre-operative quadratus lumborum block procedure with saline and then an intra-operative injection of local anesthetic (0.25% bupivacaine) at each incision site.
Receives: Drug: Quadratus lumborum block; Drug: Local Anesthetic Solution

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Intraoperative opioid use

    Total opioid dose, calculated in morphine equivalent dose, required during intraoperative anesthesia care

    Measured: From anesthesia induction to the time the patient leaves the operating room, this is considered the "in-room time". Anticipated to be between 2-6 hours. Will be assessed up to 12 hours.

  2. Immediate post-operative opioid use

    Total opioid dose, calculated in morphine equivalent dose, required after surgery prior to discharge from the hospital

    Measured: From time of arrival in the PACU to time of discharge from the hospital. Anticipated to be the same day, about 4-6 hours post-operative. Will be assessed up to 24 hours after surgery if the patient remains admitted.

Secondary outcomes (6)
  1. Opioid use after discharge

    Total opioid dose used, measured in morphine equivalent dose, from discharge to the following time points: post-operative day 1, 3, 5, 14 and 4-6 weeks post-operative.

    Measured: From discharge from the hospital to the 4-6 week post-operative appointment.

  2. Pain scores during inpatient post-operative care

    Pain scores reported by subject in the post-operative recovery areas measured by the Defense and Veterans Pain Rating Scale (DVPRS) which ranges from 0 to 10 with 0 indicating no pain and 10 indicating pain "as bad as it can be".

    Measured: From time of arrival in the PACU to time of discharge from the hospital. Anticipated to be the same day, about 4-6 hours post-operative. Will be assessed up to 24 hours after surgery if the patient remains admitted.

  3. Time to PACU discharge

    Time from arrival to transfer out of PACU, measured in minutes

    Measured: From time of arrival in the PACU to time of transfer to the second phase of post-operative care. Anticipated to be about 1-3 hours post-operative. Will be assessed up to 12 hours after surgery if the patient remains in the PACU.

  4. Voiding dysfunction

    Inability to void post-operatively or void with inappropriately high post-void residual (urinary retention)

    Measured: From time of arrival in the PACU to time of discharge from the hospital. Anticipated to be the same day, about 4-6 hours post-operative. Will be assessed up to 24 hours after surgery if the patient remains admitted.

  5. Pain scores after discharge

    Pain scores as reported by subjects on an electronic questionnaire on post-operative days 1, 3, 5, 14 and 4-6 weeks post-operative. Measured by the Defense and Veterans Pain Rating Scale (DVPRS) which ranges from 0 to 10 with 0 indicating no pain and 10 indicating pain "as bad as it can be".

    Measured: From discharge from the hospital to the 4-6 week post-operative appointment.

  6. Quality of Recovery-15 scores after discharge

    Quality of Recovery-15 scores reported by subjects by electronic questionnaire on post-operative days 1, 3, 5, 14 and 4-6 weeks post-operative. Quality of Recovery-15 scores range from 0 to 150 with higher scores indicating a better quality of recovery and lower scores indicating a poor quality of recovery.

    Measured: From discharge from the hospital to the 4-6 week post-operative appointment.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted29 Nov 2024
  2. Study start1 Dec 2024 (estimated)
  3. Primary completionDec 2025 (estimated)
  4. Study completionFeb 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
76 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06709716
Sponsor's protocol ID
WRNMMC-2024-0448
Status last verified
Nov 2024
First submitted
15 Nov 2024
Last updated
29 Nov 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Edmonds K, Hunkler K, Creedon C, Drayer S, Endicott S, Eliasen K, Jones-Cox C. Impact of preoperative quadratus lumborum block on postoperative opioid consumption after laparoscopic hysterectomy: a double-blind randomized controlled trial. Pain Manag. 2025 Nov;15(11):783-790. doi: 10.1080/17581869.2025.2556648. Epub 2025 Sep 9.

    PubMed 40923200

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Quadratus Lumborum Block (QLB), Quadratus lumborum block and Local Anesthetic Solution in people with Postoperative Pain and Laparoscopic Hysterectomy, run by Walter Reed National Military Medical Center at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 29 Nov 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Kathryn A Edmonds, MD (301-319-8866, kathryn.a.edmonds2.mil@health.mil), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Intraoperative opioid use (time frame: From anesthesia induction to the time the patient leaves the operating room, this is considered the "in-room time". Anticipated to be between 2-6 hours. Will be assessed up to 12 hours.). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06709716, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Nov 2024.

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