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

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

BackgroundSurgery 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 th...

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Bibliographic Details
Published in:Regional anesthesia and pain medicine Vol. 49; no. 11; pp. 805 - 814
Main Authors: Balsevicius, Lukas, Urbano, Paulo C. M., Hasselager, Rune Petring, Mohamud, Ahmed Abdirahman, Olausson, Maria, Svraka, Melina, Wahlstrøm, Kirsten L., Oppermann, Carolin, Gögenur, Dilara Seyma, Hølmich, Emma Rosenkrantz, Cappelen, Britt, Sækmose, Susanne Gjørup, Tanggaard, Katrine, Litman, Thomas, Børglum, Jens, Brix, Susanne, Gögenur, Ismail
Format: Journal Article
Language:English
Published: Secaucus BMJ Publishing Group Ltd 09-11-2023
BMJ Publishing Group LTD
Subjects:
Anesthesia, Local
Clinical trials
Colorectal cancer
Cytokines
Gene expression
Immunology
Injections, Spinal
Laparoscopy
Local anesthesia
Narcotics
Nerve Block
Original research
Patients
Plasma
Recovery (Medical)
Regional anesthesia
Skin cancer
Software
Surgeons
Surgery
T cell receptors
Ultrasonic imaging
Denmark
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Summary:BackgroundSurgery 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.MethodsThis 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.ResultsUsing 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).ConclusionsOur 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.
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ISSN:1098-7339
1532-8651
1532-8651
DOI:10.1136/rapm-2023-104896