Design: Randomized, controlled, double-blinded trial

Setting: University affiliated tertiary medical center

Patients or Participants: All women undergoing an elective Robotic or Laparoscopic hysterectomy. Women with chronic pain, chronic anticoagulation and Body Mass Index (BMI) > 60 kg/m² were excluded

Interventions: Randomization with a 1:1: allocation:

• QL block with Bupivacaine (0.25%, 20 ml) with saline local trocar sites infiltration
• QL block with saline with Bupivacaine (0.25%, 20 ml) local infiltration.

Stratification by Robotic and Laparoscopic approach was done.

Measurements and Main Results: Primary outcome was defined as the quality of recovery score based on (QOR-40) validated questionnaire completed 24 hours postoperatively. Secondary outcome included: dynamic pain scores, accumulated opioid consumption up to 24 hours, post-operative nausea and vomiting, surgical complications, length of hospital stay, time to first pain medication administration in PACU and adverse events. 76 women were included in each arm. Demographics characteristics were similar in both groups. Median age was 44 (IQR39-50) years, 50% of the participants were African American and median BMI was 32.8 (IQR26.5-38.5) kg/m².The mean (SD) QOR-40 was 184.4 (±10.3SD) in the QL block and 180.4 (±9.9SD) for the Local anesthesia group. Although no significant difference was found between groups using the frequentist analysis, the probability of benefit from the block was noted to be 92.7% using Bayesian analysis. All secondary outcomes were comparable between groups. Interestingly, patients undergoing the laparoscopic approach had lower QOR-40 scores compared to the robotic approach and did not seem to benefit from the QL blocks.

Conclusion: QL blocks do not significantly improve quality of recovery after elective robotic or laparoscopic hysterectomy compared to local anesthetic infiltration.