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The following is a summary of “Repeat versus Single Quadratus Lumborum Block to Reduce Opioids After Open Pancreatectomy (RESQU-BLOCK) A Randomized Clinical Trial,” published in the May 2025 issue of Annals of Surgery by Fields et al.
A historical discharge opioid prescription of 300 mg oral morphine equivalents (OME) was noted after preoperative quadratus lumborum (QL) block for open pancreatectomy, with only 5% discharge opioid-free.
Researchers conducted a retrospective study to compare opioid-free discharge rates between single-block and rescue-block postoperative analgesia bundles and to assess differences in discharge OME and patient-reported outcomes.
They performed a single-institution, unblinded phase II randomized clinical trial with intent-to-treat and post hoc Bayesian analyses. Patients undergoing open pancreatectomy were randomized equally (1:1) to receive a standardized analgesic bundle either with or without a rescue block on postoperative day 4 (POD4).
The results showed that among 106 randomized patients (44.3% female; median age 66.5 years; 84% pancreatoduodenectomy; median 5-day stay), 104 completed the trial (52 per arm). By intent-to-treat, 52% of patients receiving the second block were discharged opioid-free compared to 36.5% with the single block. Median discharge OME was 0 mg vs 25 mg, respectively. The second-block group reported lower pain and life interference scores at discharge and at 1 month.
Investigators concluded that adding a second “rescue” block did not significantly increase opioid-free discharges after opening pancreatectomy but was feasible for reducing opioid use and improving symptoms.
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