Anterior Quadratus Lumborum Block with Liposomal Bupivacaine versus Ropivacaine for Postoperative Recovery in Laparoscopic Colorectal Surgery: A Randomized Controlled Trial.

BACKGROUND

The clinical utility of liposomal bupivacaine (LB) in fascial plane blocks remains controversial, with many trials focusing on early postoperative outcomes. We investigated whether LB in quadratus lumborum block (QLB) provides an extended recovery benefit following laparoscopic colorectal surgery.

METHODS

In this randomized, double-blind, controlled, superiority trial, 120 patients undergoing laparoscopic colorectal surgery between May 12, 2025, and December 25, 2025, were allocated to receive ultrasound-guided QLB-3 with either 1.3% LB (266 mg) or 0.33% ropivacaine (132 mg). The primary outcome was the Quality of Recovery-15 (QoR-15) score at 48 hours postoperatively (POD 2). Secondary outcomes included QoR-15 at 24 hours (POD 1), opioid consumption, and safety profiles.

RESULTS

Analyzed via a linear mixed-effects model, the LB group demonstrated a significantly improved postoperative recovery trajectory compared to the ropivacaine group (Pgroup= 0.008). While QoR-15 scores were comparable at POD 1, a significant group-by-time interaction (Pinteraction= 0.042) highlighted a superior and extended recovery quality in the LB group by POD 2. Accordingly, cumulative opioid consumption was significantly reduced in the LB group during the 24-48 hour interval (7.2 vs. 12.5 mg; Pinteraction< 0.001). Multivariable regression confirmed LB as an independent predictor for enhanced recovery at POD 2 (95% CI, 0.94 to 7.43, P = 0.012). Exploratory analysis confirmed this extended benefit was consistent across both colon and rectal surgeries (P = 0.745). Crucially, no local anesthetic systemic toxicity or serious adverse events were observed.

CONCLUSION

Liposomal bupivacaine in quadratus lumborum blocks provided a statistically significant improvement in QoR 15 scores at 48 hours and an opioid sparing effect. However, the observed 4.38 point difference did not meet the prespecified minimal clinically important difference. This suggests that while the intervention provides a statistical benefit, its clinical impact may be modest within the context of an established ERAS pathway.

TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2500097657).