Quadratus Lumborum Block vs Transversus Abdominis Plane Block for Post-cholecystectomy Analgesia
- Conditions
- Laparoscopic Cholecystectomy
- Interventions
- Other: Control group (C)Other: Transversus abdominis plane Group (TAP)Other: Quadratus lumborum block Group (QL)
- Registration Number
- NCT03323684
- Lead Sponsor
- Mansoura University
- Brief Summary
In laparoscopic cholecystectomy, overall pain is a conglomerate of three different and clinically separate components: incisional pain (somatic pain) due to trocar insertion sites, visceral pain (deep intra abdominal pain), and shoulder pain due to peritoneal stretching and diaphragmatic irritation associated with carbon dioxide insufflation. Moreover, it has been hypothesized that intense acute pain after laparoscopic cholecystectomy may predict development of chronic pain (e.g., postlaparoscopic cholecystectomy syndrome). Without effective treatment, this ongoing pain may delay recovery, mandate inpatient admission, and thereby increase the cost of such care.
Recently, the uses of peripheral axial blocks that deliver local anesthetic into the transversus abdominis fascial plane have become popular for operations that involve incision(s) of the abdominal wall. Thus, the Transversus Abdominis plane (TAP) block has been shown to reduce perioperative opioid use in elective abdominal surgery, including open appendicectomy, laparotomy, and laparoscopic cholecystectomy. However, the efficacy of the TAP block is reportedly only reliable in providing analgesia below the umbilicus. The ultrasound-guided subcostal transversus abdominis (STA) block is a recently described variation on the TAP block which produces reliable supraumbilical analgesia. Deposition of local anesthetic in this plane has shown to block dermatomes T6 to T10 with an occasional spread to T12. This variant will be discussed in our study.
Currently, the Quadratus Lumborum block (QL block) is performed as one of the perioperative pain management procedures for all generations (pediatrics, pregnant, and adult) undergoing abdominal surgery. The local anesthetic injected via the approach of the posterior QL block ( QL 2 block ) can more easily extend beyond the TAP to the thoracic paravertebral space or the thoracolumbar plane, the posterior QL block entails a broader sensory-level analgesic and may generate analgesia from T7 to L1. Use of posterior QL block in laparoscopic cholecystectomy has not been investigated before and it is the variant that will be discussed in our study.
- Detailed Description
The aim of this study is to compare the analgesic efficacy of ultrasound guided posterior quadratus lumborum block and subcostal transversus abdominis plane block in laparoscopic cholecystectomy. The primary outcome will be assessment of postoperative opioid analgesic requirements. The secondary outcomes will include assessing intraoperative analgesic requirements, stress of trocar insertion and insufflation, postoperative visual analogue scale (VAS), length of stay at post-anesthesia care unit (PACU), time of first request to analgesia, incidence of nausea, and vomiting.
The study will hypothesize that quadratus lumborum block will be more superior than or equal to transversus abdominis block because it could cover all the dermatome segments from caudally L1 to cranially till T6 segments as the drug is expected to travel from the QL to the higher paravertebral spaces.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 159
- American Physical Status I or II
- Patient refusal.
- Hematological diseases
- bleeding disorders.
- Coagulation abnormality.
- Psychiatric diseases.
- Local skin infection
- sepsis at site of the block.
- Known intolerance to the study drugs.
- Body Mass Index > 40 Kg/m2.
- Emergency laparoscopic cholecystectomy
- if laparoscopic procedure converted to open.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Transversus abdominis plane Group (TAP) Paracetamol infusion Subcostal transversus abdominis plane will be performed Transversus abdominis plane Group (TAP) Ketorolac analgesia Subcostal transversus abdominis plane will be performed Control group (C) Control group (C) Postoperative analgesia will be accomplished with conjunction of paracetamol and ketorolac Control group (C) Ketorolac analgesia Postoperative analgesia will be accomplished with conjunction of paracetamol and ketorolac Transversus abdominis plane Group (TAP) Transversus abdominis plane Group (TAP) Subcostal transversus abdominis plane will be performed Quadratus lumborum block Group (QL) Quadratus lumborum block Group (QL) Quadratus lumborum block will be performed Quadratus lumborum block Group (QL) Ketorolac analgesia Quadratus lumborum block will be performed Quadratus lumborum block Group (QL) Paracetamol infusion Quadratus lumborum block will be performed Control group (C) Paracetamol infusion Postoperative analgesia will be accomplished with conjunction of paracetamol and ketorolac Transversus abdominis plane Group (TAP) fentanyl Subcostal transversus abdominis plane will be performed Quadratus lumborum block Group (QL) fentanyl Quadratus lumborum block will be performed Control group (C) fentanyl Postoperative analgesia will be accomplished with conjunction of paracetamol and ketorolac
- Primary Outcome Measures
Name Time Method Cumulative postoperative fentanyl consumption (total dose given in micrograms) For 24 hours after surgery
- Secondary Outcome Measures
Name Time Method Mean arterial blood pressure (mmHg) For 4 hours after start of anaesthesia Changes in intra-operative mean arterial blood pressure values
Dermatomal distribution of the extent of the blockade will be assessed by pinprick method the first one hour after surgery Assessment of dermatomal distribution of the block for evaluating the success or failure of the block
Postoperative pain severity will be assessed using VAS For 24 hours after surgery The severity of postoperative pain will be measured and recorded by using the visual analogue scale (VAS) for pain, where 0 is equal to no pain and 10 indicates the worst possible pain
Cumulative intraoperative fentanyl consumption (total dose given in micrograms) For 4 hours after start of anaesthesia Cumulative use of fentanyl during intra-operative period
Heart rate For 4 hours after start of anaesthesia Changes in intra-operative heart rate values
Time for the first request to rescue analgesia (in minutes) For 24 hours after surgery Time for first request to rescue analgesia
length of stay at PACU (in minutes) For 24 hours after surgery Incidence of postoperative nausea and vomiting For 24 hours after surgery
Trial Locations
- Locations (2)
Mansoura University, Faculty of Medicine
🇪🇬Mansourah, DK, Egypt
Mansoura University
🇪🇬Mansourah, DK, Egypt