Analgesia of Erector Spinae Plane Block Versus Quadratus Lumborum Block
Condition: Colorectal Cancer
MeSH terms: Colorectal Neoplasms
Study type: Interventional

Summary: 
      Colorectal cancer is the third most common cancer worldwide. These patients usually undergo
      open surgical resection of cancer under general anaesthesia.

      The aim of this study is to detect whether the Erector spinae plan block or Quadratus
      lumborum block will provide the most ideal analgesia for these patients. Erector spinae plan
      block is a novel analgesic technique that provides both visceral and somatic analgesia due to
      its communication with the paravertebral space. Quadratus lumborum block is a truncal nerve
      block usually used for intra-abdominal surgeries. Ultrasound guidance increases the accuracy
      and safety of both techniques. A local anaesthetic mixture of Bupivacaine 0.25% and
      dexamethasone will be used for both techniques.
    

Detailed description: 
      Erector spinae plane block and quadratus lumborum block are analgesic techniques suitable for
      open colorectal cancer surgeries. postoperative pain score, serum levels of biomarkers of
      stress (cortisol and CRP), primary hemodynamics, time to first rescue analgesic request, the
      total amount of rescue analgesic consumption and postoperative nausea and vomiting are the
      parameters of comparison between both techniques.
    

Intervention name(s): Erector spinae plane block; Quadratus lumborum block; Propofol; Fentanyl NCS; Atracurium Injectable Product; Endotracheal intubation; Anesthesia Maintenance; Muscle Relaxation
Intervention type(s): Other; Other; Drug; Drug; Drug; Other; Drug; Drug
Intervention description(s): For each side, the eighth thoracic transverse process will be identified by a linear US transducer (HFL38_10-5 MHz), puncture will be performed in the plane in the craniocaudal direction until the needle contacts the transverse process, and 20 ml of bupivacaine 0.25% and 4 mg dexamethasone will be injected visualizing the hydrodissection. After 30 minutes, the degree of sensory block in the trunk will be assessed by the pinprick test and any undesirable motor weakness will be recorded as a side effect.; For each side, shamrock sign with three leaves (psoas major muscle anteriorly, the erector spinae muscle posteriorly and the quadratus lumborum muscle adherent to the apex of the transverse process of the L4 vertebral body) will be identified by a curved array US transducer (6-2MHz), puncture will be performed in-plane, the needle will be advanced through the quadratus lumborum muscle penetrating the ventral proper fascia of the quadratus lumborum muscle, and 20 mL of bupivacaine 0.25% and 4 mg dexamethasone will be injected in that space visualizing the hydrodissection. After 30 minutes, the degree of sensory block in the trunk will be assessed by the pinprick test and any undesired motor weakness will be recorded as a side effect; Propofol (2 mg/kg); Fentanyl (1µg/Kg); atracurium (0.5mg/kg); endotracheal intubation; Inhalational isoflurane in oxygen/air mixture; atracurium boluses (0.2 mg/Kg/20 minutes) will be used for maintenance of general anesthesia
Intervention MeSH terms: Fentanyl; Propofol; Atracurium
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care