Clinical Efficacy of the Quadratus Lumborum Block for Analgesia in Kidney Transplant Surgery
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- CHU de Reims
- 入组人数
- 48
- 试验地点
- 1
- 主要终点
- consumption of morphine
研究概览
简要总结
Kidney transplant is considered as a moderate painful surgery. Unfortunately, patients with chronic kidney disease are not able to degrade opioid drugs and are therefore most likely to be subjected to the secondary effects of their consumption. Current strategies aim to find pain relief substitutes in order to decrease the use of opioids, specially after surgery, during patient recovery. Loco-regional analgesia consists of administering local anesthesic directly in specific nerves and is being used in several surgical procedures. In various abdominal surgeries, a loco-regional analgesia called "tranversus abdominis Plane Block" has been associated with decreased morphine consumption and better post-operative conditions. In kidney transplant, the definitive efficacy of this loco-regional analgesia is not established, due to controversial clinical results.
The goal of our study is to test the analgesia advantage of a variant of the Tranversus Abdominis Plane Block, called Quadratus lumborum block, which targets a muscle called quadratus lumborum, in association with general anesthesia, on post-surgery recovery and opioid intake.
详细描述
Post-operative pain after a kidney transplant can be moderate to severe, but analgesic options are limited. Clearance of the active metabolite of morphin is low in patients with chronic kidney disease, which imposes a strict monitoring of morphin administration. Therefore pain control is difficult and non-optimal.
Reducing both pain and opioid consumption during the per and post operative periods constitutes a major stake, and involves the use of locoregional anesthesia techniques.
The recent literature recommends the realization of a transversus abdominal plane block, despite contradictory results concerning the expected effect.
Even though peridural analgesia remains the gold standard in many types of surgeries, it is not recommended in case of renal transplant due to multiple secondary effects.
The quadratus lumborum bloc echoguid is a recent technique of locoregional analgesia, used in lower abdominal surgeries (appendicectomy, césarian, digestive resection, ...) "because of a prolonged duration of action and a sensitive anesthesia spreading" (which provides a much wider field of analgesia?). This technique is not described for the kidney transplant surgery.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- Double (Participant, Investigator)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients eligible for kidney transplant surgery at the CHU de Reims
- •Patients agreeing to participate in the research and having signed the informed consent
- •Adult patients
- •Patients affiliated to a social security scheme
排除标准
- •Legally protected
- •Known allergy to local anesthetics used
- •Manifest polyneuropathy
- •ASA score > 4
- •Pregnancy, breastfeeding
- •Contraindications to QLB
- •Technique refusal
- •Previous kidney transplant
- •History of major abdominal surgery
结局指标
主要结局
consumption of morphine
时间窗: Day 1
Total consumption of morphine during the first day after surgery
次要结局
- consumption of ULTIVA(Day 0)
- Pain evaluation(Hour 12)