Quadratus Lumborum Block vs Erector Spinal Block for Post Abdomen Surgery Analgesia

NCT ID: NCT05446727

Last Updated: 2025-09-04

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 100 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-05-01
• Study Completion Date: 2023-12-31

Brief Summary

Prior to surgery, patients will be stratified into groups according to the type of surgical procedure. The anticipated groups are as follows:

Patients with colorectal cancer

Patients with prostate cancer

Patients with renal cancer

Patients undergoing surgery for gallbladder cholelithiasis. The Erector Spinal Block (ESP) is based on the deposition of the local anesthetic in the inter-fascial space between the dorsal extensor muscle and the intercostal muscles at the height of the transverse processes. The scope of the blockade covers the dorsal and ventral branches of the thoracic spinal nerves, but also in most cases the investigetors are able to obtain a wide distribution of the drug into the paravertebral space by "permeating" the local anesthetic through the fascial compartments. The clinical effect of the blockade is due to blocking the nerve structures of the paravertebral space (spinal nerve branches and the sympathetic trunk). The scope of the blockade, after its execution at the level of Th5, most often includes the segments from Th1 to L1.

Currently, the Quadratus Lumborum block (QL block) is performed as one of the perioperative pain management procedures for all generations (pediatrics, pregnant, and adult) undergoing abdominal surgery. The local anesthetic injected via the approach of the anterior QL block ( QL1 block ) can more easily extend beyond the TAP to the thoracic paravertebral space or the thoracolumbar plane, the posterior QL block entails a broader sensory-level analgesic and may generate analgesia from T7 to L1.

Detailed Description

In abdomen surgery, overall pain is a conglomerate of three different and clinically separate components: incisional pain (somatic pain), visceral pain (deep intra abdominal pain), and shoulder pain due to peritoneal stretching and diaphragmatic irritation associated with carbon dioxide insufflation. Moreover, it has been hypothesized that intense acute pain after labdomen surgery may predict development of chronic pain. Without effective treatment, this ongoing pain may delay recovery, mandate inpatient admission, and thereby increase the cost of such care.

Conditions

Pain, Acute; Postoperative Pain; Anesthetics, Local

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Quadratus Lumborum block group

Experimental: Quadratus Lumborum block group Patients were placed in the lateral decubitus position. After skin disinfection, a linear high-frequency ultrasound probe guarded with a sterile cover was set above the iliac crest and shifted cranially until the three abdominal wall muscles were distinguished. Then, it was moved medially until latissimus dorsi and quadratus lumborum (QLM) muscles were shown within identical short-axis views. A 21-gauge needle was inserted from the edge of the probe using an in-plane technique and advanced into the fascia over the QLM. After ensuring negative aspiration for blood, 30 ml of 0.35% ropivacaine bilateral was injected slowly into the fascial interspace.

Group Type: EXPERIMENTAL

Ropivacaine injection

Intervention Type: DRUG

30ml of 0.35% ropivacaine bilaterally

erector spinae planae block

The ESP block was performed with the patient in a sitting position. After skin disinfection, a linear high-frequency (L14-6NS) ultrasound probe, covered with a sterile sheath, was positioned sagittally 1-2 cm lateral to the midline at the level of the ninth thoracic vertebra (T9). The T9 level was earlier identified by palpating the spinous process of the seventh cervical vertebra and counting down nine intervertebral spaces. After identifying the erector spinae muscle (ESM) and transverse process, a 21-gauge needle was inserted deep into the ESM in a cranio-caudal direction, using an in-plane technique. The needle was advanced, ensuring that it crossed all muscle layers until it contacted the transverse process. A total of 60 mL of 0.35% ropivacaine was given. This procedure was performed bilaterally on each patient.

Group Type: EXPERIMENTAL

Ropivacaine injection

Intervention Type: DRUG

30ml of 0.35% ropivacaine bilaterally

Interventions

Ropivacaine injection

30ml of 0.35% ropivacaine bilaterally

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• Patients requiring abdomen surgery
• Patients of age 18 and over
• BMI < 40
• Patients who are expected to stay in-hospital overnight after surgery

Exclusion Criteria

• Patient refusal
• Contraindications to paravertebral blocks: Infection at the site of needle insertion, empyema, allergy to local anesthetic drugs, and tumor occupying the thoracic paravertebral space, coagulopathy, bleeding disorder or therapeutic anticoagulation
• Known allergy to local anesthetics
• Inability to provide informed consent
• Inability to use a PCA due to languate or comprehension barriers
• BMI >= 40
• Any patient on opioids for greater than or equal to 3 months duration prior to surgery
• Patients with chronic pain syndromes

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 90 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Jagiellonian University

OTHER

Sponsor Role: lead

Responsible Party

Tomasz Skladzien

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Jagiellonian University

Krakow, Maloposkie, Poland

Countries

Poland

References

Tomasz S, Pawel M, Michal C, Szpunar W, Jan S, Tomasz L, Anna K, Renata B, Olga S, Tomasz D, Michal T. Effects of Erector Spinae Plane Block and Quadratus Lumborum Block on Postoperative Opioid Consumption in Laparoscopic Kidney Surgery: A Randomized Controlled Clinical Trial. Pain Res Manag. 2025 Aug 4;2025:8869716. doi: 10.1155/prm/8869716. eCollection 2025.

Reference Type: DERIVED

PMID: 40791636 (View on PubMed)

Other Identifiers

1072.6120.32.2022

Identifier Type: -

Identifier Source: org_study_id