To compare the effictiveness of ultrasound guided Quadratus lumborum block using injection bupivacaine and intravenous tramadol for postoperative analgesia in unilateral renal surgeries- A randomised comparative study

INTRODUCTION

Despite advances in both surgical and anaesthesia techniques, post operative pain remains an important concern in patients undergoing renal surgeries. The postoperative pain following surgical procedures not only prolongs the duration of hospital stay but also increases morbidity and effect enhanced recovery programs. Peripheral nerve blocks and interfascial plane blocks are considered safer, providing long lasting analgesia as compared to central neuraxial blockade, and systemic analgesia (i/v, oral) facilitating lesser morbidity and early discharges. Main advantage of Quadratus lumborum block is that it provides higher dermatome coverage (T6-L1), better sensory coverage and visceral analgesia.The ultrasound is a valuable adjunct in peripheral nerve block practice due to clarity and direct visualisation of anatomical landmarks providing better and long lasting blockage with lesser complications. Hence, this study aims to evaluate the analgesic efficacy of ultrasound guided Quadratus lumborum block for postoperative analgesia in patients undergoing unilateral renal surgeries.

 METHODOLOGY

The day before surgery pre anaesthetic assessment of all patients will be done and all the patients will be explained about the NBM period, visual analogue scale (VAS score) and study protocol in their local vernacular language and written informed consent will be obtained for the same. Patients will be divided into two groups by odd and even method (30 in each group). Patients in group A will be given ultrasound guided quadratus lumborum block and patients in group B will be given Inj. Tramadol 1.5mg/kg as analgesic at the end of surgery. General anaesthesia will be standardised to all patients. Inj.Fentanyl 1mcg/kg will be administered as a top up after 60 minutes from onset of surgery.  At the end of surgery, patients of Group A will receive Quadratus lumborum block (type: anterior Shamrock’s approach) in lateral position using an ultrasound machine with a curvilinear 2-5 MHz probe using Inj. Bupivacaine 0.25% 25ml. Patients of Group B will receive Inj.Tramadol 1.5mg/kg at the end of surgery.  Haemodynamic parameters of the patient will be monitored at every 5 minutes interval till 20 minutes after giving the block and then every 20 minutes till 2 hours. After extubation, the pain will be assessed by the VAS scale of 1-10, 30 minutes post procedure till 2 hour, then at 4, 8, 12, 18, 24 hour. The patients will be administered Inj.Tramadol 1.5mg/kg if their VAS score >3 and the time duration from administration of block to VAS > 3 will be considered as duration of analgesia. The patients will be monitored from the time of extubation to 24 hours postoperatively and total consumption of Inj. Tramadol in this period will be noted. The incidence of adverse effects such as nausea, vomiting, hypotension, tachycardia etc., will be noted down and treated accordingly.

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