Comparing the Efficacy of Epidural and Quadratus Lumborum Analgesia After Open Nephrectomy Surgery
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Open Nephrectomy Surgery
- Sponsor
- The Cleveland Clinic
- Enrollment
- 57
- Locations
- 1
- Primary Endpoint
- Total opioid consumption
- Status
- Completed
- Last Updated
- 5 years ago
Overview
Brief Summary
This study aims to assess if Quadratus Lumborum (QL) blocks are non-inferior to epidural analgesia for pain control and opioid consumption through the third postoperative day in patients having open partial nephrectomy. Patients satisfying all inclusion and exclusion criteria will be randomized in a 1:1 ratio to either epidural catheter or QL catheter.
Detailed Description
QL blocks with a single shot and catheters infusions may be an alternative to epidural analgesia. However, the relative efficacy, safety, and cost of the two approaches remain unclear. Epidural analgesia is frequently used as a component of multimodal analgesia for thoracic and abdominal surgery. QL block has been introduced recently as a component of multimodal analgesia for lower thoracic and abdominal surgery. In general, insertion of QL catheter is easier and safer than insertion of epidural catheters. QL catheter management is also less complicated than epidural analgesia (fewer catheter displacements and less hemodynamic compromise) and decreases the level of complexity in postoperative care. Our hypothesis is that the subcostal QL approach with a continuous catheter is non-inferior to epidural analgesia for pain control and opioid consumption in patients having open partial nephrectomy procedure.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Adults having for open unilateral partial nephrectomy surgery.
Exclusion Criteria
- •Intolerance or allergy to opioids
- •Previous radical nephrectomy surgery/midline incision
- •Contraindication to epidural analgesia
- •Contraindications to QL block
- •Chronic pain characterized by: i.Opioids use for more than 30 consecutive days within the 3 preoperative months at the dose equal or greater than equivalent of 15 mg of morphine ii.Abdominal pain for more than 6 months, present most days of the week-
Outcomes
Primary Outcomes
Total opioid consumption
Time Frame: Arrival to post anesthesia care unit until 72 hours after surgery
Total IV morphine-equivalent doses used, started postoperatively at the time of arrival to post anesthesia care unit until 72 hours after surgery.
Postoperative pain
Time Frame: Arrival to post anesthesia care unit until 72 hours after surgery
Time-weighted average verbal rating scale for pain until 72 hours after operation as a time-weighted average, based on nursing assessments at four-hour intervals. The verbal rating scale ranges from 0 to 10, with 0 indicating no pain and 10 indicating worst pain imaginable. Time-weighted average pain is defined as the sum of each time interval between two adjacent pain score measurements multiplied by the average of the two corresponding pain scores divided by the time interval between the first and last pain scores.
Secondary Outcomes
- Duration of postoperative hospitalization(From the date of surgery to hospital discharge, assessed up to 12 months.)
- Patient Global Assessment(Three days after surgery)
- Doses of antiemetic medications administered(Arrival to post anesthesia care unit until the third day after surgery)
- Episodes of hypotension(Arrival to post anesthesia care unit until the third day after surgery)