Erector Spinae Plane Block vs Quadratus Lumborum Block for Laparoscopic Nephrectomy

Not Applicable

Recruiting

• Conditions: Kidney Failure; Kidney Diseases
• Interventions: Other: Postoperative analgesia management with Paracerol® and IV PCA with Talinat®; Other: Quadratus lumborum plane block; Other: Erector spinae plane block

• Registration Number: NCT06298227
• Lead Sponsor: Istanbul Medipol University Hospital

Brief Summary

Ultrasound (US) guided Quadratus Lumborum Block (QLB) is performed at the level of the 12th rib, in the parasagittal oblique plane, at the L1-L2 level. As there are modifications of the block generally local anesthetic is given between quadratus lumborum (QL) and psoas major (PM) muscles (Anterior QLB). The QLB provides a sensory block between T7 - L1. Therefore, QLBs are used to provide postoperative analgesia for abdominal, obstetric, gynecologic, and urologic surgeries.

US-guided erector spinae plane block (ESPB) is performed at the level of the T11 transverse process. After visualization of the erector spinae (ES) muscle and the transverse process, local anesthetic is injected under the ES muscle. ESPB provides a sensory block of the anterior, posterior, and lateral thoracic and abdominal walls accordingly it's used for postoperative analgesia after thoracal wall repairs, thoracotomies, percutaneous nephrolithotomies, nephrectomies, and ventral hernia repairs.

This study aims to compare the effectiveness of US-guided ESPB and QLB on postoperative pain control after laparoscopic nephrectomy.

Detailed Description

Nephrectomy for renal transplantation is a commonly performed procedure. The laparoscopic live donor nephrectomy (LLDN) is associated with many benefits and has become the gold standard for kidney retrieval surgery. As compared to open donor nephrectomy (ODN), LLDN has been shown to have less post-operative pain, shorter hospital stays, and faster recovery. Even though LLDN is less traumatic, some patients undergoing laparoscopic live donor nephrectomy still suffer significant postoperative pain require parenteral opioids, and have a risk for chronic pain.

The postoperative pain mechanism of LLDN is multifactorial - port pain, pain caused by incisions to retrieve the kidney, pelvic organ nociception, diaphragmatic irritation, and discomfort of a urinary catheter. Opioids, epidural anesthesia, Transversus Abdominal Plane (TAP) Block, and local infiltration of local anesthetics are used to prevent postoperative pain after LLDN.

In this study, the investigators aim to compare the effectiveness of US-guided ESPB and QLB on postoperative pain control after laparoscopic nephrectomy.

Study Timeline

• Study First Submitted: 2024-02-06
• Study First Submitted QC: 2024-02-29
• Study First Posted: 2024-03-07
• Study Start: 2024-03-11
• Status Verified: 2025-03
• Last Update Submitted: 2025-03-12
• Last Update Posted: 2025-03-14
• Primary Completion: 2025-04-30
• Study Completion: 2025-04-30

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 60

Inclusion Criteria

• American Society of Anesthesiologists (ASA) classification I-II
• Scheduled for living donor laparoscopic nephrectomy under general anesthesia

Exclusion Criteria

• history of bleeding diathesis,
• receiving anticoagulant treatment,
• known local anesthetics and opioid allergy,
• infection of the skin at the site of the needle puncture,
• pregnancy or lactation,
• patients who refuse the procedure or participation in the study

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Group ESPB = Erector spinae plane block group	Postoperative analgesia management with Paracerol® and IV PCA with Talinat®	ESPB will be performed
Group QLB = Quadratus lumborum block group	Quadratus lumborum plane block	QLB will be performed
Group ESPB = Erector spinae plane block group	Erector spinae plane block	ESPB will be performed
Group QLB = Quadratus lumborum block group	Postoperative analgesia management with Paracerol® and IV PCA with Talinat®	QLB will be performed

Primary Outcome Measures

Name	Time	Method
Amount of total opioid consumption (Fentanyl PCA) at the first 24 hours period postoperatively	Changes from baseline opioid consumption at postoperative 1, 2, 4, 8, 16 and 24 hours.	The primary aim is to compare postoperative opioid consumption from the PCA device.

Secondary Outcome Measures

Name	Time	Method
Need for rescue analgesia (meperidine)	Postoperative 24 hours period	The secondary aim is to compare rescue analgesia used in the postoperative 24 h.
Adverse events	Postoperative 24 hours period	The secondary aim is to compare the adverse events (nausea, vomiting, itching) related to opioid use.
Pain scores (Numerical rating scale-NRS)	Changes from baseline pain scores at postoperative 1, 2, 4, 8, 16 and 24 hours	The secondary aim is to compare NRS at the postoperative 24 h. Postoperative pain assessment will be performed using the NRS (0 = no pain, 10 = the most severe pain felt). The NRS scores will be recorded

Trial Locations

Locations (1)

Istanbul Medipol University Mega Hospital Complex; 🇹🇷 Istanbul, Bağcılar, Turkey