The Comparison of Erector Spinae Plane Block and Quadratus Lumborum Block on Postoperative Analgesia in Patients Undergoing Laparoscopic Nephrectomy: A Randomized, Prospective, Controlled Study
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Kidney Diseases
- Sponsor
- Istanbul Medipol University Hospital
- Enrollment
- 60
- Locations
- 1
- Primary Endpoint
- Amount of total opioid consumption (Fentanyl PCA) at the first 24 hours period postoperatively
- Status
- Recruiting
- Last Updated
- 4 months ago
Overview
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.
Investigators
Ayse Ince
Principal Investigator
Istanbul Medipol University Hospital
Eligibility Criteria
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
Outcomes
Primary Outcomes
Amount of total opioid consumption (Fentanyl PCA) at the first 24 hours period postoperatively
Time Frame: 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 Outcomes
- Need for rescue analgesia (meperidine)(Postoperative 24 hours period)
- Adverse events(Postoperative 24 hours period)
- Pain scores (Numerical rating scale-NRS)(Changes from baseline pain scores at postoperative 1, 2, 4, 8, 16 and 24 hours)