Effect of anterior quadratus lumborum block with ropivacaine on the immune response after laparoscopic surgery in colon cancer: a substudy of a randomized clinical trial.

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  • Additional Information
    • Source:
      Publisher: BMJ Country of Publication: England NLM ID: 9804508 Publication Model: Electronic Cited Medium: Internet ISSN: 1532-8651 (Electronic) Linking ISSN: 10987339 NLM ISO Abbreviation: Reg Anesth Pain Med Subsets: MEDLINE
    • Publication Information:
      Publication: 2018- : [London, United Kingdom] : BMJ
      Original Publication: Secaucus, NJ : Churchill Livingstone, c1998-
    • Subject Terms:
      Ropivacaine*/administration & dosage ; Laparoscopy* ; Anesthetics, Local*/administration & dosage ; Colonic Neoplasms*/surgery ; Nerve Block*/methods; Humans ; Male ; Double-Blind Method ; Female ; Aged ; Middle Aged ; Pain, Postoperative/prevention & control ; Pain, Postoperative/diagnosis ; Abdominal Muscles/innervation ; Abdominal Muscles/drug effects ; Colectomy/adverse effects ; Treatment Outcome ; Cytokines/blood ; Cytokines/metabolism
    • Abstract:
      Background: Surgery induces a temporal change in the immune system, which might be modified by regional anesthesia. Applying a bilateral preoperative anterior quadratus lumborum block has proven to be a safe and effective technique in pain management after abdominal and retroperitoneal surgery, but the effect on the immune response is not thoroughly investigated.
      Methods: This study is a substudy of a randomized, controlled, double-blinded trial of patients undergoing laparoscopic hemicolectomy due to colon cancer. Twenty-two patients were randomized to undergo either a bilateral anterior quadratus lumborum nerve block with a total of 60 mL ropivacaine 0.375% or placebo with corresponding isotonic saline injections. The main objective of this exploratory substudy was to investigate the systemic immune response in the first postoperative day by examining changes in blood transcript levels (n=750) and stimulated secretion of cytokines (n=17) on ex vivo activation with microbial ligands and anti-CD3/CD28.
      Results: Using unsupervised data analysis tools, we observed no effect of the bilateral anterior quadratus lumborum nerve block on gene expression in immune cells (permutational multivariate analysis of variance using distance matrices: F=0.52, p=0.96), abundances of major immune cell populations (Wilcoxon rank-sum test: p>0.05), and stimulated cytokine secretion (Wilcoxon rank-sum test: p>0.05).
      Conclusions: Our study provides evidence that administration of bilateral anterior quadratus lumborum nerve block as a part of a multimodal analgesic regimen in an enhanced recovery after surgery for laparoscopic hemicolectomy in this cohort does not alter the systemic immune response. Trial registration number NCT03570541.
      Competing Interests: Competing interests: None declared.
      (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
    • Contributed Indexing:
      Keywords: Anesthesia, Local; Injections, Spinal; Nerve Block
    • Molecular Sequence:
      ClinicalTrials.gov NCT03570541
    • Accession Number:
      7IO5LYA57N (Ropivacaine)
      0 (Anesthetics, Local)
      0 (Cytokines)
    • Publication Date:
      Date Created: 20231109 Date Completed: 20241104 Latest Revision: 20241120
    • Publication Date:
      20241121
    • Accession Number:
      10.1136/rapm-2023-104896
    • Accession Number:
      37945063