Preoperative Versus Postoperative Quadratous Lunborum Block in Nephrectomy

NCT ID: NCT05860309

Last Updated: 2023-05-16

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 100 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-06-30
• Study Completion Date: 2023-12-31

Brief Summary

A multimodal analgesia regimen is suggested after nephrectomy, although some patients still report agonising pain. Regional anesthesia approaches may improve postoperative pain management and reduce the requirement for opioids after renal surgery.QLB provides early and rapid pain relief

Detailed Description

In the immediate postoperative period, nerve blocks are considered a type of multimodal analgesia and have recently been proposed as analgesic options for patients undergoing open nephrectomy .

Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. The main barrier to early postoperative ambulation is postoperative pain, which also lengthens hospital stays and raises the risk of respiratory problems and venous thromboembolism. Therefore, strict perioperative pain management can have both immediate and long-term advantages .

QLB provides early and rapid pain relief and allows early ambulation in certain patient populations. Multiple case studies also confirmed the QLB to be a rescue block after different surgical procedures. Complications associated with the performance of abdominal wall blocks are fortunately very rare. However, studies on the effect of anterior QLB on postoperative opioid consumption are scarce .

Regional anesthesia is quickly moving toward using ultrasound guidance as the gold standard. The use of ultrasound has significant advantages over traditional treatments such as nerve stimulation and loss of resistance. The improved safety and efficacy that ultrasound brings to regional anaesthesia will help promote its use and realise the benefits that regional anaesthesia has over general anaesthesia, such as decreased morbidity and mortality, superior postoperative analgesia, cost-effectiveness, decreased postoperative complications and an improved postoperative course .

The aim of the present study is to compare the effectiveness of ultrasound-guided preoperative to postoperative QLB on the postoperative pain scores after Radical nephrectomy.

Conditions

Regional Blocks; Renal Surgery

Study Design

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

Study Groups

preoperative quadratous lumborum block

patients weill recieve preoperative ultrasound guided quadratous lumborum block at lateral position before start of surgery after induction of general anesthesia

Group Type: ACTIVE_COMPARATOR

quadratous lumborum block

Intervention Type: OTHER

The patient will be placed in the lateral position, after sterilization.. QLB will be done using ultrasound, The probe will be positioned superior to the iliac crest, in the transverse orientation, at the posterior axillary line. The Shamrock sign will be identified at the L4 level, and the insulated nerve block needle will be advanced from posterior to anterior, through the QL muscle, until the needle tip is visualized in the interfascial plane between the QL muscle and psoas muscle. As the correct needle placement is confirmed with 2-3 mL of saline, 20 mL of 0.25% bupivacaine will be injected ensuring that the psoas muscle will be pushed deeply.

postoperative quadratous lumborum block

patients weill recieve postoperative ultrasound guided quadratous lumborum block at lateral position at the end of surgery before recovery from general anesthesua

Group Type: ACTIVE_COMPARATOR

quadratous lumborum block

Intervention Type: OTHER

The patient will be placed in the lateral position, after sterilization.. QLB will be done using ultrasound, The probe will be positioned superior to the iliac crest, in the transverse orientation, at the posterior axillary line. The Shamrock sign will be identified at the L4 level, and the insulated nerve block needle will be advanced from posterior to anterior, through the QL muscle, until the needle tip is visualized in the interfascial plane between the QL muscle and psoas muscle. As the correct needle placement is confirmed with 2-3 mL of saline, 20 mL of 0.25% bupivacaine will be injected ensuring that the psoas muscle will be pushed deeply.

Interventions

quadratous lumborum block

The patient will be placed in the lateral position, after sterilization.. QLB will be done using ultrasound, The probe will be positioned superior to the iliac crest, in the transverse orientation, at the posterior axillary line. The Shamrock sign will be identified at the L4 level, and the insulated nerve block needle will be advanced from posterior to anterior, through the QL muscle, until the needle tip is visualized in the interfascial plane between the QL muscle and psoas muscle. As the correct needle placement is confirmed with 2-3 mL of saline, 20 mL of 0.25% bupivacaine will be injected ensuring that the psoas muscle will be pushed deeply.

Intervention Type: OTHER

Other Intervention Names

myofascial block

Eligibility Criteria

Inclusion Criteria

• o Patients aged between 18 - 60 years old.

• Both sexes.
• Physical Status: ASA I and II.

Exclusion Criteria

• o Refusal of procedure or participation in the study .

• Physical status: ASA III or above .
• Infection at site of injection.
• Psychiatric illness .
• CNS Diseases like epilepsy, stroke …etc.
• History or evidence of coagulopathy .
• Allergies to drug used (Bupivacaine 0.5%).
• Patients who suffered from allergy to local anesthetics .
• Difficult visualization of the anatomy.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Ain Shams University

OTHER

Sponsor Role: lead

Responsible Party

Sanaa Farag Mahmoud Wasfy

assistant professor of anesthesia and intensive care

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

sanaa F wasfy

Role: PRINCIPAL_INVESTIGATOR

Ain Shams University

Locations

Ainshams hospitals

Cairo, , Egypt

Countries

Egypt

Central Contacts

sanaa F wasfy

Role: CONTACT

sanaawasfy@gmail.com

01061262757

Wael S Abdelmegied

Role: CONTACT

sanaawasfy@gmail.com

01282269727

References

Borys M, Szajowska P, Jednakiewicz M, Wita G, Czarnik T, Mieszkowski M, Tuyakov B, Galkin P, Rahnama-Hezavah M, Czuczwar M, Piwowarczyk P. Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Decreases Persistent Postoperative Pain Severity in Patients Undergoing Both Open and Laparoscopic Nephrectomies-A Randomized Controlled Trial. J Clin Med. 2021 Aug 15;10(16):3590. doi: 10.3390/jcm10163590.

Reference Type: BACKGROUND

PMID: 34441884 (View on PubMed)

Other Identifiers

MS 183/2023

Identifier Type: -

Identifier Source: org_study_id