Quadratus Luborum Block Using Bupivacaine Versus Bupivacaine-Dexamethasone in Laparoscopic Cholecystectomy
Condition: Post Operative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      The aim of the present study was to compare the effectiveness of transmuscular Quadratus
      Lumborum block using Bupivacaine versus Bupivacaine- Dexamethasone in providing analgesia in
      patients undergoing laparoscopic cholecystectomy.

      Because postoperative pain after laparoscopic surgery is complex, specialists suggest that
      effective analgesic treatment should be a multimodal support. Quadratus lumborum block (QLB)
      is a new abdominal truncal block for controlling somatic pain in both the upper and lower
      abdomen. Dexamethasone, through its anti-inflammatory and blocking effects on neural
      discharge, and nociceptor C fibers transmission could be used as a local anesthetic adjuvant.
    

Detailed description: 
      The patients were randomly allocated into three groups each contains (30) patient. Control
      group (C) received bilateral ultrasound guided quadratus lumborum block using (20 ml 0.9%
      normal saline + 1mL 0.9% normal saline) in each side ,Bupivacaine group (B) received
      bilateral quadratus lumborum block using (20 ml Bupivacaine hydrochloride 0.25% + 1mL 0.9%
      normal saline) in each side and Dexamethasone-Bupivacaine group (D) received bilateral
      quadratus lumborum block using (20 ml Bupivacaine hydrochloride 0.25% + 1 mL dexamethasone
      "4mg") in each side.

      The following variables: heart Rate, mean arterial Blood Pressure, peripheral oxygen
      saturation, visual analogue pain scale , time to first analgesic request, total Analgesic
      requirement in the first 24 hours, patient satisfaction and complications were Recorded and
      compared between groups.
    

Intervention name(s): TQL block with saline; TQL block with Bupivacaine; TQL block with Bupivacaine and dexamethasone
Intervention type(s): Drug; Drug; Drug
Intervention description(s): drug: saline 21 ml 0.9% normal saline administered on each side as bilateral TQL blocks Drug: fentanyl With induction of general anaesthesia, fentanyl (1 microgram.kg) will be given. Intraoperatively, fentanyl boluses (0.5 microgram.kg) will be given in case of increase in intraoperative mean arterial blood pressure or heart rate of more than 20% of baseline for longer than 5 minutes.
Drug: Paracetamol Paracetamol infusion (15 mg.kg) will be given by intravenous infusion after induction of general anesthesia. Postoperatively, 1 g of paracetamol will be given by intravenous infusion to all cases every 8 hours.
Drug: Ketorolac analgesia In PACU Ketorolac 30 mg ampoule will be given by intravenous infusion to all cases Drug: Nalbuphine Nalbuphine boluses 0.1 mg. /kg will be given as rescue analgesia if VAS is more than3.
Device: ultrasound-guided nerve block Transmuscular quadratus lumborum block, ultrasound-guided; Drug: saline
1mL 0.9% normal saline administered on each side as bilateral TQL blocks drug: Bupivacaine 20 ml Bupivacaine hydrochloride 0.25% administered on each side as bilateral TQL blocks Drug: fentanyl With induction of general anaesthesia, fentanyl (1 microgram.kg) will be given. Intraoperatively, fentanyl boluses (0.5 microgram.kg) will be given in case of increase in intraoperative mean arterial blood pressure or heart rate of more than 20% of baseline for longer than 5 minutes.
Drug: Paracetamol 15 mg.kg will be given by intravenous infusion after induction of general anesthesia. Postoperatively, 1 g of paracetamol will be given to all cases every 8 hours.
Drug: Ketorolac In PACU Ketorolac 30 mg ampoule will be given by intravenous infusion to all cases Drug: Nalbuphine Nalbuphine boluses 0.1 mg. /kg will be given as rescue analgesia if VAS is more than 3.
Device: ultrasound-guided nerve block Transmuscular quadratus lumborum block; Drug: dexamethasone
1 mL dexamethasone "4mg" administered on each side as bilateral TQL blocks drug: Bupivacaine 20 ml Bupivacaine hydrochloride 0.25% administered on each side as bilateral TQL blocks Drug: fentanyl With induction of general anaesthesia, fentanyl (1 microgram.kg) will be given. Intraoperatively, fentanyl boluses (0.5 microgram.kg) will be given in case of increase in MBP or HR of more than 20% of baseline for longer than 5 minutes.
Drug: Paracetamol Paracetamol infusion (15 mg.kg) will be given by intravenous infusion after induction of general anesthesia. Postoperatively, 1 g of paracetamol will be given by intravenous infusion to all cases every 8 hours.
Drug: Ketorolac In PACU Ketorolac 30 mg ampoule will be given by intravenous infusion to all cases Drug: Nalbuphine Nalbuphine boluses 0.1 mg. /kg will be given as rescue analgesia if VAS is more than 3.
Device: ultrasound-guided nerve block Transmuscular quadratus lumborum block
Other intervention name(s): C Group; B Group; D Group
Intervention MeSH terms: Dexamethasone; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: randomized, double blind
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Quadratus Lumborum Block; Laparoscopic Cholecystectomy; dexamethasone