Comaprison Between QLB and ESPB in Patients for PCNL Operation

NCT ID: NCT04277611

Last Updated: 2022-09-07

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 92 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-04-20
• Study Completion Date: 2022-06-30

Brief Summary

comparing the subcostal oblique Quadratus Lumborum block and the Erector Spinae plane block in patients undergoing percutaneous nephrolithotomy operation to get the best and longest postoperative analgesic effect.

Detailed Description

Here the investigators are going to compare between the Anterior approach for the subcostal oblique Quadratus Lumborum block (QLB) and the Erector Spinae Plane Block (ESPB) to determine their level of spread and their value in controlling postoperative pain in patients scheduled for Percutaneous Nephrolithotomy surgery. We hypothesized that quadratus lumborum is not inferior regarding the duration of analgesia when compared to erector spinae in patients undergoing percutaneous nephrolithotomy under general anesthesia.

Conditions

Pain, Postoperative

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: SUPPORTIVE_CARE
• Blinding Strategy: QUADRUPLE

Study Groups

QLB

The patient is in the prone position, an ultrasound probe is placed in a transverse, oblique, and paramedian orientation approximately lateral to the posterior axillary line. The needle is then inserted in-plane from the medial side of the transducer and advanced laterally to enter the interfascial plane between the Quadratus Lumborum muscle and the kidney. We confirmed that the local anesthetic appeared to press down the kidney in the ultrasound image

Group Type: ACTIVE_COMPARATOR

Subcostal Oblique Quadratus Lumborum Block and Erector Spinae Plain Block.

Intervention Type: PROCEDURE

patients undergo general anesthesia,will be put in prone position.In case of Quadratus Lumborum block 1-3 mL of normal saline is injected to produce hydro-dissection and spread cranially between the QL and kidney. The corresponding ultrasonographic sign is a lunar-shaped hypo-echoic fluid collection observed between the long axis of the kidney and QL muscle. 20 ml Bupivacaine 0.5%, 10 ml Lidocaine 2%, and 10 ml normal saline is administered. In case of the ESPB The location of the needle tip is confirmed by hydro-dissection and after visualizing the fluid spread lifting the Erector Spinae off the transverse process, 20 ml bupivacaine 0.5%, 10 ml Lidocaine 2%, and 10 ml normal saline is injected.

ESPB

Using aseptic technique, an ultrasound probe is placed at the T9 vertebral level. After identifying the ribs and sliding towards the midline in a longitudinal parasagittal orientation, the overlying Erector Spinae is identified by visualization of the transition between the rib and transverse apophysis a block needle is inserted in plane with ultrasound beam and is advanced in a cephalo-caudal direction until the tip contacted the transverse process.

Group Type: ACTIVE_COMPARATOR

Subcostal Oblique Quadratus Lumborum Block and Erector Spinae Plain Block.

Intervention Type: PROCEDURE

patients undergo general anesthesia,will be put in prone position.In case of Quadratus Lumborum block 1-3 mL of normal saline is injected to produce hydro-dissection and spread cranially between the QL and kidney. The corresponding ultrasonographic sign is a lunar-shaped hypo-echoic fluid collection observed between the long axis of the kidney and QL muscle. 20 ml Bupivacaine 0.5%, 10 ml Lidocaine 2%, and 10 ml normal saline is administered. In case of the ESPB The location of the needle tip is confirmed by hydro-dissection and after visualizing the fluid spread lifting the Erector Spinae off the transverse process, 20 ml bupivacaine 0.5%, 10 ml Lidocaine 2%, and 10 ml normal saline is injected.

Interventions

Subcostal Oblique Quadratus Lumborum Block and Erector Spinae Plain Block.

patients undergo general anesthesia,will be put in prone position.In case of Quadratus Lumborum block 1-3 mL of normal saline is injected to produce hydro-dissection and spread cranially between the QL and kidney. The corresponding ultrasonographic sign is a lunar-shaped hypo-echoic fluid collection observed between the long axis of the kidney and QL muscle. 20 ml Bupivacaine 0.5%, 10 ml Lidocaine 2%, and 10 ml normal saline is administered. In case of the ESPB The location of the needle tip is confirmed by hydro-dissection and after visualizing the fluid spread lifting the Erector Spinae off the transverse process, 20 ml bupivacaine 0.5%, 10 ml Lidocaine 2%, and 10 ml normal saline is injected.

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Both sex
• Age: 18-60
• ASA (American Society of Anesthesiologists) class I and II
• Elective surgery
• Patients undergoing PNL surgery

Exclusion Criteria

• Patient's refusal
• Allergy or contraindications to drugs used in the study
• Emergency surgery
• Psychiatric disorders
• Severely co-morbid patients
• Inflammation or infection over injection site
• Bleeding diathesis; INR more than 1.5 and Platelet count less than 100,000/mm3
• Peripheral neuropathy
• Obese patients BMI ≥35
• Patients on previous opioid therapy
• Pre-operative haemoglobin <10 mg/dl
• Inability to properly describe postoperative pain to investigators
• Coagulation abnormalities
• History of drug addiction or alcohol abuse
• History of Previous renal surgery

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 60 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Assiut University

OTHER

Sponsor Role: lead

Responsible Party

Peter Bassem Halim Gadelsyed

Resident Doctor in Anesthesia, postoperative ICU and pain management department

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Amr Thabet, Lecturer

Role: STUDY_DIRECTOR

Assiut University

Alaa Attia, Professor

Role: STUDY_CHAIR

Assiut University

Locations

Assiut University Hospitals

Asyut, , Egypt

Countries

Egypt

Other Identifiers

QLB and ESPB comparison

Identifier Type: -

Identifier Source: org_study_id