Effect of Anterior Quadratus Lumborum Block at the Lateral Supra-Arcuate Ligament Combined with Esketamine on the Quality of Postoperative Recovery After Laparoscopic Radical Surgery for Elderly Patients with Colorectal Cancer: A Randomized Controlled Trial.
Zhen Dai, Ming Yang, Huan Liu et al.
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In 30 seconds
This single-centre, randomized, placebo-controlled trial evaluated anterior quadratus lumborum block at the lateral supra-arcuate ligament (QLB-LSAL), low-dose esketamine, or their combination in patients aged 60 years or older undergoing laparoscopic radical colorectal cancer surgery. Of 90 assigned patients, 88 were analysed. The prespecified day-3 QoR-40 score was higher with the combination than with esketamine alone (adjusted difference 8.30, 95% CI 4.37-12.23, Tukey P<0.001). The combination also improved early pain-related outcomes and reduced opioid use compared with esketamine alone; adverse-event incidence did not differ between groups.
Key findings
- On postoperative day 3, QoR-40 was higher with QLB-LSAL plus esketamine than with esketamine alone (adjusted difference 8.30, 95% CI 4.37-12.23, Tukey P<0.001).
- The day-1 QoR-40 difference between combination therapy and esketamine alone was 12.07 (95% CI 7.66-16.47, P<0.001).
- The combination group had better comfort and pain scores, lower remifentanil consumption, and fewer day-1 pump activations than the esketamine-only group.
- Adverse-event incidence did not differ between groups; adjusted anxiety-score differences were not significant after multiplicity correction.
Why it matters
Recovery quality, postoperative pain, and opioid exposure are relevant outcomes for older adults undergoing major colorectal surgery. This trial suggests that combining a regional block with low-dose esketamine may improve early recovery beyond esketamine alone, while also reporting no between-group difference in adverse-event incidence. The findings add comparative evidence for this perioperative approach, but apply to the studied surgical and patient population.
What to keep in mind
The trial was single-centre and analysed 88 patients. Follow-up outcomes reported here are limited to the early postoperative period.