Erector Spinae Plane Block Versus Paravertebral Block Versus Quadratus Lumborum Block on Postoperative Analgesia After Pelvi-ureteric Surgeries: A Randomized Double-Blinded, Non-inferiority Trial
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Erector Spinae Plane Block
- Sponsor
- Kafrelsheikh University
- Enrollment
- 90
- Locations
- 1
- Primary Endpoint
- The total postoperative morphine consumption
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
The aim of this study is to compare the analgesic efficacy of erector spinae plane block versus thoracic paravertebral block versus quadratus lumborum block on postoperative analgesia after pelvi-ureteric surgeries.
Detailed Description
Opioid-based analgesia plays a significant role in the control of postsurgical pain; however, use of opioid may lead to significant side effects (e.g., nausea and vomiting) and adverse events (e.g. respiratory depression), which may be associated with significantly longer hospital stays and higher hospital costs in the postsurgical setting . Thoracic paravertebral block (TPVB) is a classic trunk block with definite analgesic effect for both somatic and visceral pain. Quadratus Lumborum block (QLB) is a widely used regional anesthesia technique as well. It has been used for reducing postoperative pain after cesarean section, laparotomy or laparoscopic procedure and hip surgery. Erector spinae plane block (ESPB) is a novel inter-fascial plane block first introduced by Forero et al. in 2016 , providing wide-ranging analgesia in lung surgery, laparoscopy, mastectomy, and pediatric surgery. The proposed mechanism of ESPB is that distribution of local anesthetic solution spreads into the para-vertebral space and epidural space, which then blocks the dorsal, ventral, and traffic branches of spinal nerve. ESPB, TPVB and QLB III have been shown to improve analgesic outcome after urological surgeries.
Investigators
Mohamed Fouad Algyar
Lecturer of Anesthesiology, Surgical Intensive Care and Pain Medicine
Kafrelsheikh University
Eligibility Criteria
Inclusion Criteria
- •Age 18-65 years
- •Both genders
- •American Society of Anesthesiologists (ASA) physical status I-III
- •Undergoing elective pelvi-ureteric surgeries.
Exclusion Criteria
- •Body Mass Index \> 30 kg/m
- •Contraindication of deep nerve block such as allergic to anesthetic drug, coagulation disorder, and infection at the injection site.
- •Chronic opioids dependence or chronic pain over 3 months.
- •Use of medication such as gabapentin-pregabalin could affect pain perception.
- •Unable to communicate preoperatively due to severe dementia, language barrier, or neuropsychiatric disorder.
- •Unable to perform nerve block procedure due to difficult anatomy through ultrasound scan.
Outcomes
Primary Outcomes
The total postoperative morphine consumption
Time Frame: 48 hours postoperatively
Total amount of rescue analgesic in the first 48 hours postoperative will be measured.
Secondary Outcomes
- Patients' satisfaction after surgery.(48 hours Postoperatively)
- Access time of first analgesic(48 hours Postoperatively)
- Access post-operative pain scores(48 hours Postoperatively)