efficacy of quadratus lumborum ii block for laparoscopic sleeve gastrectomy

Conditions: Morbid Obesity; High BMI

Summary: the ql 2 block is a novel fascial plane block recently described by blanco and colleagues in which local anesthetic is deposited adjacent to the antero-lateral aspect of the quadratus lumborum muscle. this results in posterior spread of local anesthetic through the middle layer of the thoraco-lumbar fascia, which theoretically communicates with the paravertebral space resulting in potentially longer-lasting and denser analgesia than wound infiltration. the ql 2 block derives from the tap block, which is also a fascial plane block that is commonly used to treat pain following surgery involving the anterior abdominal wall. however, the ql block's more posterior location has recently been shown to provide a longer lasting and more profound analgesic effect than the tap block, possibly by communicating with the paravertebral space. although the tap has been shown to be effective in a variety of surgical procedures involving an anterior abdominal wall incision including laparoscopic bariatric surgery the ql 2 block has until now, not been studied in the context of bariatric surgery.

the ql 2 block is a novel fascial plane block recently described by blanco and colleagues in which local anesthetic is deposited adjacent to the antero-lateral aspect of the quadratus lumborum muscle. this results in posterior spread of local anesthetic through the middle layer of the thoraco-lumbar fascia, which theoretically communicates with the paravertebral space resulting in potentially longer-lasting and denser analgesia than wound infiltration. like the more commonly used transversus abdominis plane (tap) block, the ql 2 block targets the anterior rami of t7-t12, ilioinguinal, iliohypogastric, and the lateral cutaneous branches of l1-l3. the ql 2 block derives from the tap block, which is also a fascial plane block that is commonly used to treat pain following surgery involving the anterior abdominal wall. however, the ql block's more posterior location has recently been shown to provide a longer lasting and more profound analgesic effect than the tap block, possibly by communicating with the paravertebral space. although the tap has been shown to be effective in a variety of surgical procedures involving an anterior abdominal wall incision including laparoscopic bariatric surgery the ql 2 block has until now, not been studied in the context of bariatric surgery. conventional therapy has consisted of surgical infiltration of the incision ports with bupivacaine 0.25%. the study team proposes a study to compare the analgesic effects of the ql 2 block with conventional therapy, consisting of surgical wound infiltration, for postoperative analgesia following laparoscopic gastric sleeve gastrectomy.

Eligibility criteria:
inclusion criteria: * patients scheduled to undergo laparoscopic gastric sleeve gastrectomy * 18-65 years of age * bmi\> 35 kg/m2. exclusion criteria: * contraindications to administration of local anesthesia (e.g. local anesthetic allergy) * contraindication/allergy to acetaminophen or ketorolac * history of substance abuse or chronic opioid use * coagulopathy * patients receiving systemic anticoagulation * local infection * asa 4

Keywords: sleeve gastrectomy quadratus lumborum block bariatric surgery