Efficacy Of Quadratus Lumborum II Block For Laparoscopic Sleeve Gastrectomy
Condition: Morbid Obesity; High BMI
MeSH terms: Obesity, Morbid
Study type: Interventional
Phase: Phase 4

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.
    

Detailed description: 
      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.
    

Intervention name(s): Bupivacaine
Intervention type(s): Drug
Intervention description(s): Bupivacaine Hcl 0.25% Inj
Intervention MeSH terms: Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Treatment
Keywords: Sleeve gastrectomy; Quadratus lumborum block; Bariatric surgery