Ultrasound Guided Quadratus Lumborum Block Versus Ultrasound Guided Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Abdominal Surgeries
试验速览
- 阶段
- 不适用
- 入组人数
- 82
- 试验地点
- 2
- 主要终点
- The first time to rescue analgesia
研究概览
简要总结
Postoperative pain after laparoscopic abdominal surgeries can be severe. Despite multimodal analgesia protocols, administration of high doses of opioids is often required hindering early mobilization and discharge of the patient from the day surgery setting and is suboptimal in an Early Recovery after Surgery setting.
Settings and design A prospective randomized double blinded study.
Aim To evaluate and compare the analgesic effect of ultrasound-guided erector spinae plane (ESP) block with ultrasound-guided posterior Quadratus Lumborum Block in laparoscopic abdominal surgeries.
Patients and methods This randomized prospective study will be carried for 6 months on adult patients with American Society of Anesthesiologists (ASA) Physical Status Class I and II, aged between 30 and 60 years.
详细描述
The role of regional anaesthesia is well established in abdominal surgery, with epidural analgesia being the gold standard in perioperative analgesia since the early 1900s.However early mobilization, minimally invasive surgical techniques, and pharmacologic venous thromboprophylaxis are now recognized as key components of efficient surgical recovery. The search for motor-sparing, less-invasive, safer, and efficacious alternatives to epidural analgesia has been prioritized.
With the introduction of the ultrasound machine in the operating theatres, the practice of regional anaesthesia has been changed from landmark-based techniques to regional blocks administered under direct vision through the ultrasound machine. The ultrasound-guided Erector Spinae Plane (ESP) block is a novel truncal interfacial regional technique.
Two variations of the ESP block for thoracic and abdominal procedures have recently been described in literature. The injection site is either at the level of T5 transverse process, resulting in spread between the C7 and T8 segmental levels, or at the levels of the T7-T9 transverse processes, resulting in spread between the T6 and T12 segmental levels. Quadratus lumborum block (QLB) is a posterior extension of the TAP block. It was first described by Dr Blanco, and it was later modified by Sauter et al. These blocks target both somatic structures covering the anterior abdominal wall, with suggestions of abdominal visceral coverage as well, most commonly using a lateral, posterior, or anterior approach.
The lateral approach (previously QL1) involves depositing local anaesthesia at the lateral border of the QL muscle, anterior to the aponeurosis of the transversus abdominis muscle and within the anterior thoracolumbar fascia. The posterior approach (previously QL2) involves injecting posterior to the QL muscle, in the middle thoracolumbar fascia. The anterior approach (also called the transmuscular (QL block) involves injecting anterior to the QL muscle, between it and the psoas major muscle and in the anterior thoracolumbar fascia.
Patients and Methods
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Double (Participant, Care Provider)
入排标准
- 年龄范围
- 30 Years 至 60 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Patients will be included in the study aged 30-60 years.
- •ASA Physical Status Class I and II.
- •Elective laparoscopic abdominal surgery under general anesthesia.
排除标准
- •Infection at injection site.
- •History of allergy to local anesthetics.
- •Coagulation disorders.
- •Physical or mental diseases which may interfere with the evaluation of pain scores.
- •Kidney failure or liver cell failure.
结局指标
主要结局
The first time to rescue analgesia
时间窗: (recorded within the first 24 hour postoperatively)
The time to ask for postoperative analgesia is the time from the end of operation to patient reporting Visual analogue scale ≥ 5. Pain assessments are conducted by a researcher who is unaware of the grouping
次要结局
- Visual analogue scale (VAS)(measured immediate after surgery, 2,6,12,24 hours postoperatively)