Quadratus lumborum block combined with multidimensional psychological intervention (CBT + mindfulness) on recovery and psychological status after gasless laparoscopic surgery in elderly patients with gynecological malignancies: A randomized controlled tri

Background: Postoperative pain and negative emotions are common in elderly patients with gynecological malignancies. High-quality evidence is lacking on how to achieve effective analgesia and psychological improvement during gasless laparoscopic surgery. Objective: To explore the effects of quadratus lumborum block combined with cognitive behavioral therapy and mindfulness training on postoperative pain control, relief of negative emotions, and functional recovery in this population. Methods: A single-center, prospective, randomized controlled trial was conducted. A total of 120 elderly patients with gynecological malignancies meeting the inclusion criteria were enrolled and randomly assigned in a 1:1 ratio to the intervention group or control group. In the intervention group, quadratus lumborum block and multidimensional psychological intervention were applied perioperatively, in addition to routine analgesia and health education. The primary outcomes included pain scores at 6, 24, and 48 h postoperatively. Opioid consumption and patient-controlled analgesia (PCA) bolus counts within 48 h were recorded. Secondary outcomes were postoperative changes in SAS and SDS scores, functional recovery, and complications. Statistical methods were used to analyze differences between groups. Results: Pain scores in the intervention group at 24 and 48 h postoperatively were significantly lower than those in the control group (P < 0.05, repeated-measures ANOVA). Total opioid consumption and PCA bolus counts within 48 h were significantly reduced (P < 0.01, t-test). SAS and SDS scores decreased more significantly at 24 and 48 h postoperatively in the intervention group (P < 0.05, t-test). Times to ambulation and first flatus and defecation were significantly shorter (P < 0.05, t/U test), and hospital stay was reduced (P < 0.05, t-test). SF-36 scores before discharge were higher than in the control group (P < 0.05, t-test), but no significant difference in complication rates was observed (P > 0.05, χ2 or Fisher test). Conclusion: Quadratus lumborum block combined with multidimensional psychological intervention effectively reduced postoperative pain, decreased opioid requirements, improved anxiety and depression, and promoted functional recovery and quality of life, proving to be safe and feasible.