Comparison of Paravertebral Block and Subcostal Transversus Abdominis Plane Block in Laparoscopic Nephrectomy
- Conditions
- AnesthesiaPain, PostoperativeAnalgesia
- Interventions
- Registration Number
- NCT05723341
- Lead Sponsor
- Istanbul University
- Brief Summary
Most of the patients undergoing laparoscopic partial/radical nephrectomy can experience moderate or severe postoperative pain, and inadequate control of this pain can cause negative consequences such as development of chronic pain, pulmonary and cardiac events, and side effects of long term opioid usage. Due to these adverse outcomes, ultrasonography-guided plane blocks can be beneficial for these patients to decrease opioid consumption. In this study, the investigators aim to compare ultrasonography-guided plane blocks: Paravertebral block and subcostal transversus abdominis plane block and traditional method: patient controlled analgesia with opioids. The investigators hypothesized that analgesic efficacy in both paravertebral and subcostal TAP blocks will have similar outcomes but better than traditional method.
- Detailed Description
More than half of patients undergoing laparoscopic partial/radical nephrectomy develop moderate or severe postoperative pain. Inadequate control of postoperative pain may delay early mobilization and rehabilitation, increase pulmonary and thromboembolic events, prolong hospital stay, and decrease patient satisfaction. Inadequate postoperative pain control may lead to the development of chronic pain, resulting in long-term opioid use. In the traditional analgesia model provided with opioids, patients may develop side effects such as nausea, vomiting, hypotension, loss of consciousness, and respiratory depression. For this reason, it would be more rational to provide analgesia with regional methods, which are decided according to the suitability of the patient and the surgical procedure, rather than the use of intravenous drugs. Ultrasonography-guided plane blocks, one of the main elements of multimodal analgesia, are used more frequently with the introduction of ultrasonography into daily practice. These blocks are frequently preferred in daily practice as they reduce opioid consumption by providing effective postoperative analgesia with low complication rates and ease of application.
In the ultrasonography-guided paravertebral block, local anesthetic is injected into the triangle constituted by superior costotransvers ligament, parietal pleura and vertebral body where the spinal nerves emerge from the intervertebral foramen. Ipsilateral somatic and sympathetic nerve blockade is observed. It is a body block that can be used to provide both analgesia and anesthesia. Paravertebral block provides successful postoperative analgesia, reduces the decline in postoperative respiratory function, accelerates the recovery of respiratory mechanics, and reduces postoperative vomiting, allowing earlier initiation of oral intake.
Ultrasonography-guided subcostal transversus abdominis plane block is a relatively safe and simple body block in which local anesthetic is injected into the fascial plane located between posterior rectus sheath and transversus abdominis muscle. The transversus abdominis plane is the fascial plane superficial to the transversus abdominis muscle, the innermost muscular layer of the anterolateral abdominal wall. The subcostal transversus abdominis plane block ideally anesthetizes the intercostal nerves T6-T9 between the rectus abdominis sheath and the transversus abdominis muscle. It is a truncal block that has drawn attention recently, both because it is easier to apply and because it is a more peripheral block.
In this study the investigators aim to compare the effects of two truncal blocks on postoperative pain, morphine consumption, chronic pain and complications.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 91
- Age of 18-75
- Patients who are ASA (American Society of Anesthesiology): I-II
- Patients who will have laparoscopic partial/radical nephrectomy
- Patients who volunteer to participate in the study
- Patients with any kind of coagulopathy
- Patients with severe cardiac, pulmonary, renal or liver disease
- Patients who have difficulty comprehending the IV PCA device
- Patients with local anesthetic allergy
- Patients with chronic opioid use
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Paravertebral Block Group Morphine In this group, preoperative ultrasound-guided paravertebral block will be performed ipsilateraly via peripheral block needle with 20 ml bupivacaine %0,25 in the paravertebral space. Subcostal Transversus Abdominis Plane Block Group Bupivacain In this group, preoperative ultrasound-guided subcostal transversus abdominis plane block will be performed ipsilateraly via peripheral block needle with 20 ml bupivacaine %0,25 into the fascial plane between erector spine muscle and transverse process Paravertebral Block Group Bupivacain In this group, preoperative ultrasound-guided paravertebral block will be performed ipsilateraly via peripheral block needle with 20 ml bupivacaine %0,25 in the paravertebral space. Intravenous Patient Controlled Analgesia Morphine In this group, postoperative patient controlled analgesia with morphine will be preferred for postoperative analgesia method. Subcostal Transversus Abdominis Plane Block Group Morphine In this group, preoperative ultrasound-guided subcostal transversus abdominis plane block will be performed ipsilateraly via peripheral block needle with 20 ml bupivacaine %0,25 into the fascial plane between erector spine muscle and transverse process
- Primary Outcome Measures
Name Time Method Postoperative Intravenous Total Morphine Consumption Up to 24 hours The total dosage of intravenous morphine consumption in 24 hours.
- Secondary Outcome Measures
Name Time Method Rescue analgesia administration amounts Up to 24 hours Time of postoperative rescue analgesic requirement time.
Incidence of complications due to the regional blocks Up to first week Incidence of hematoma, pneumothorax (pleural puncture), local anesthetic toxicity, infection vs.
Chronic postoperative pain Up to 90th day Patients' chronic pain will be assessed by the examiner questioning each patient about the pain status on postoperative 90th day.
Lenght of Hospital Stay Up to first week Lenght of Hospital Stay
Postoperative Visual Analog Score (VAS) Up to 24 hours A visual analog score (VAS) requires the patient to rate their pain on a defined scale. For example, 0-10 where 0 is no pain and 10 is the worst pain imaginable
Trial Locations
- Locations (1)
Istanbul University
🇹🇷Istanbul, Turkey