Use of local anaesthetic for Quadratus Lumborum muscle Block in patients undergoing surgical removal of uterus and its effect on requirement of post operative pain relief medications

Phase 4

Completed

Conditions: Unspecified condition associated with female genital organs and menstrual cycle,

Registration Number: CTRI/2017/02/007905

Lead Sponsor: Department of Anaesthesia and Intensive Care

Brief Summary: Abdominal hysterectomy is one of the most frequently performed gynecological surgery these days. Post procedural pain is the main concern in patients undergoing any operative intervention. In addition to the somatic and visceral components in the early post-operative period, inadequate pain relief has a propensity to progress to chronic pain syndromes that may have debilitating impact on the quality of life The pfannenstiel incision which is the most commonly used incision in cesarean section and total abdominal hysterectomy(TAH) has also been associated with development of chronic pain syndromes if the acute pain of surgery is not managed adequately.

Many analgesic practices have been carried out to alleviate the pain associated with abdominal hysterectomy such as use of oral analgesics which may be opioid or non-opioid, intravenous patient control analgesia system, local infiltration at the surgical site and neuraxial analgesia via epidural or intrathecal route. There is rising concern with the use of opioids as the sole analgesic modality as it can lead to significant amount of post-operative nausea vomiting (PONV), pruritus, drowsiness, respiratory depression and other systemic side effects. Use of local infiltration or non-opioid preparations as unimodal analgesic are usually inadequate in providing pain relief. Neuraxial analgesia via epidural or intrathecal route for post-operative pain control may not be a convenient route as they need catheter based continuous infusion or repeated bolus to provide adequate effect. Other modes of analgesia available for patient undergoing abdominal hysterectomy are the ultrasound guided nerve blocks (ilio-inguinal nerve block) and inter-fascial plane blocks (Transversus abdominus muscle plane block).Since the advent of ultrasound in anaesthesia various modalities are being defined and refined to provide pain relief considering the safety profile associated with techniques done with the aid of ultrasound. With increasing application of ultrasound in anaesthesia practice, interest in interfacial plane blocks has also increased owing to improved visualization of the anatomical structures.A recent development in the field of post-operative analgesia is the ultrasound guided Quadratus lumborum block (QLB) which has been shown to provide effective analgesia in patients undergoing lower abdominal surgeries. Originally described by Blanco in 2007, QLB was further modified by Borglum, who deposited the drug in the inter-fascial plane between quadratus lumborum muscle and psoas major in a trans-muscular approach.This leads to extensive thoracolumbar anaesthesia (T6-L1). He also postulated the spread of local anaesthesia to thoracic paravertebral spread (TPVS), as both psoas and quadratus lumborum muscles have their embryonic origin and insertion within the thoracic cage.

Both cesarean section and TAH utilize the same surgical field and abdominal incision (pfannenstiel incision). The nerves that innervate the supra pubic and lower abdominal portion may get damaged or trapped leading to neuroma formation especially when the incision is extended beyond the lateral edges of the rectus sheath, thus leading to neuropathic pain in the post-operative period.This may lead to development of chronic pain.

Hence, the present study aims at comparing the effectiveness of ultrasound guided quadratus lumborum block (QLB) with intravenous Patient controlled analgesia (IV-PCA) for adequate post-operative analgesia in patients scheduled to undergo total abdominal hysterectomy (TAH).

Detailed Description: Not available

Recruitment & Eligibility

Status: Completed

Sex: Female

Target Recruitment: 90

Inclusion Criteria

Females suffering from pathology requiring total abdominal hysterectomy 2.
American Society of Anesthesiologists physical status I-II.

Exclusion Criteria

History of relevant drug allergy 2.
History of psychiatric illness, substance abuse 3.
Severe cardiovascular, respiratory, liver diseases metabolic or neurological disease 4.
Chronic treatment with analgesics 5.Coagulopathy 6.Infection at planned injection site 7.Psychological inability of the patient to understand visual analogue scale 8.History of intake of drugs such as imipramine, theophylline, fluvoxamine and antiarrhythmic agents.

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
To analyze the intensity of post-operative pain relief in both groups by visual analogue scale	30mins, 1hr, 4hrs, 8hrs, 12hrs, 24hrs, 36hrs and 48 hrs.

Secondary Outcome Measures

Name	Time	Method
To analyze total cumulative morphine consumption in both the groups over 48 hours	30mins, 1hr, 4hrs, 8hrs, 12hrs, 24hrs, 36hrs and 48 hrs.

Trial Locations

Locations (1): Government Medical College and Hospital
🇮🇳
Chandigarh, CHANDIGARH, India
Government Medical College and Hospital
🇮🇳Chandigarh, CHANDIGARH, India
Dr Tanvi Khera
Principal investigator
7696227898
tanvi.khera92@gmail.com