Quadratus Lumborum Block Versus Erector Spinae Plane Block As Analgesic Alternatives During Extracorporeal Shock Wave Lithotripsy
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Pain
- Sponsor
- South Valley University
- Enrollment
- 90
- Locations
- 1
- Primary Endpoint
- Analgesic Effect: cumulative opioid dose
- Status
- Completed
- Last Updated
- last year
Overview
Brief Summary
This study is designed to compare analgesic effect of both the ultrasound (US)-guided QLB and ESPB blocks during ESWL and their effect on stone fragmentation.
Detailed Description
Urinary tract calculi, one of the most common benign urological diseases, is seen in 12% of patients and has a recurrence rate of approximately 50%. Management of renal calculi is known to be affected by many factors, specially tolerance of pain during ESWL and how it is controlled. Pain experienced during ESWL is thought to occur when shock waves from the lithotripter reach superficial structures such as skin and also deeper structures such as the ribs, nerves and the kidney capsule. There are three main factors that contribute to the propagation of pain at these structures: shock wave (SW) pressure, distribution, and focal area size . Conventionally, pain during ESWL is managed by basic analgesics such as NSAIDs, which can also aid in stone clearance. Other methods of analgesia also have been studied and tested. Quadratus lumborum block (QLB) was first described by Blanco in 2007, it blocks T7-L1 nerve fibres in most of the cases. Studies have reported its use in the management of postoperative pain after hip surgeries. "Erector Spinae Plane Block" (ESPB) is another such block, that is increasingly tried for the management of postoperative pain for breast surgery, thoracic surgery, and also upper abdominal surgeries. ESPB when given at the lumbar region gives blockade from C7-T2 to L2-L3.
Investigators
Mohamed Gaber Ahmed
Lecturer in anesthesiology, intensive care and pain management
South Valley University
Eligibility Criteria
Inclusion Criteria
- •Informed written consent obtained
- •Age 18-60
- •American Society of Anesthesiologists(ASA) physical status: I, II
- •Stone pelvis less than 2.5 cm
- •Indicated for ESWL
Exclusion Criteria
- •refusal of participation by parents or caregivers.
- •ASA physical status: \> II
- •Stone pelvis \>2.5 cm
- •Chronic pain
- •On chronic NSAID or opioid
- •Substance addict
- •Known local anesthetic drug sensitivity.
- •Preexisting infection at block site
- •Coagulopathy or anticoagulation.
Outcomes
Primary Outcomes
Analgesic Effect: cumulative opioid dose
Time Frame: At 30 minutes
Comparing analgesic Effect of both QLB and ESPB by calculating the total opioid consumption over the total duration of session (approximately 30 minutes)
Secondary Outcomes
- Stone fragmentation: clearance rate(one week after ESWL session)
- Adverse effects(immediately after 20 minutes of intervention)
- Block failure rate(Immediately After 20 minutes of intervention)
- The regional block time(procedure (At the end of intervention))
- Feasibility of visualisation(procedure (At the end of intervention))
- Stone fragmentation: shockwave energy(at 30 minutes)
- Patient satisfaction(At 30 minutes)