Subcostal Approach to Anterior Quadratus Block Versus Thoracic Paravertebral Block for Laparoscopic Nephrectomy
Condition: Anesthesia; Analgesia; Acute Pain; Patient Controlled Analgesia
MeSH terms: Acute Pain
Study type: Interventional

Summary: 
      In this study, it was aimed to evaluate the effects of subcostal anterior quadratus lumborum
      block (S-QLB3) and thoracic paravertebral block (TPVB) on postoperative acute pain scores and
      opioid consumption in the first 24 hours after laparoscopic nephrectomy surgery.
    

Detailed description: 
      Laparoscopic partial or radical nephrectomy is associated with severe acute postoperative
      pain. Acute pain is mediated by inflammation, activation of spinal pathways and muscle spasm.
      Poor pain control may reduce patient satisfaction, delay postoperative ambulation and
      increase the incidence of pulmonary and cardiac complications.

      Facial plane blocks, an important element of multimodal analgesia, can reduce the dosage of
      opioids, minimize side effects and improve the quality of postoperative recovery. Quadratus
      lumborum (QL) block is a relatively new technique. Subcostal anterior QL block (S-QLB3)
      involves injection in the plane between the psoas and QL muscles. Thoracic paravertebral
      block (TPVB) is frequently used in thoracic and general surgery and its significant analgesic
      efficacy has been demonstrated in the literature. It has been used successfully as part of
      multimodal analgesia in renal surgery.

      In this study, it was aimed to evaluate the effects of S-QLB3 block and TPVB block on pain
      scores and opioid consumption in patients undergoing laparoscopic nephrectomy.

      Patients will be divided into two groups:

      Group S-QLB3:A unilateral S-QLB3 block will be performed (0.4 ml/kg of 0.25% bupivacaine +
      1:400.000 adrenaline). In addition, IV morphine-PCA will be applied postoperatively for 24
      hours.

      Group TPVB: A unilateral TPV block will be performed (0.4 ml/kg of 0.25% bupivacaine +
      1:400,000 adrenaline). In addition, IV morphine-PCA will be applied postoperatively for 24
      hours.
    

Intervention name(s): Subcostal Anterior Quadratus Lumborum Block; Thoracic Paravertebral Block
Intervention type(s): Procedure; Procedure
Intervention description(s): S-QLB3 block will be performed 30 min. before general anesthesia. For anterior QL block via subcostal approach, 0.4 ml/kg of 0.25% bupivacaine + 1:400.000 adrenaline will be injected into the interfacial plane between the QLM and PMM.
IV-PCA: The requested dose will be 20µg/kg morphine, the lock-in time will be 6-10 minutes, the 4-hour limit will be 80% of the total calculated dose.; TPVB block will be performed 30 min. before general anesthesia. TPVB will be performed at T10 transverse process level, 0.4 ml/kg of 0.25% bupivacaine + 1:400.000 adrenaline will be injected into the paravertebral space.
IV-PCA: The requested dose will be 20µg/kg morphine, the lock-in time will be 6-10 minutes, the 4-hour limit will be 80% of the total calculated dose.
Other intervention name(s): S-QLB3; TPVB
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A block randomization list will be created by a doctor who does not participate in patient follow-up using a web-based program, 'Research Randomizer (Urbaniak and Plous 2013)'.
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Regional Anesthesia; Acute Pain Scores; Subcostal Anterior Quadratus Lumborum Block; Thoracic Paravertebral Block; Morphine Consumption