ESPB vs PVB vs QLB After Pelvi-ureteric Surgeries
Condition: Erector Spinae Plane Block; Paravertebral Block; Quadratus Lumborum Block; Analgesia
Study type: Interventional

Summary: 
      The aim of this study is to compare the analgesic efficacy of erector spinae plane block
      versus thoracic paravertebral block versus quadratus lumborum block on postoperative
      analgesia after pelvi-ureteric surgeries.
    

Detailed description: 
      Opioid-based analgesia plays a significant role in the control of postsurgical pain; however,
      use of opioid may lead to significant side effects (e.g., nausea and vomiting) and adverse
      events (e.g. respiratory depression), which may be associated with significantly longer
      hospital stays and higher hospital costs in the postsurgical setting .

      Thoracic paravertebral block (TPVB) is a classic trunk block with definite analgesic effect
      for both somatic and visceral pain.

      Quadratus Lumborum block (QLB) is a widely used regional anesthesia technique as well. It has
      been used for reducing postoperative pain after cesarean section, laparotomy or laparoscopic
      procedure and hip surgery.

      Erector spinae plane block (ESPB) is a novel inter-fascial plane block first introduced by
      Forero et al. in 2016 , providing wide-ranging analgesia in lung surgery, laparoscopy,
      mastectomy, and pediatric surgery. The proposed mechanism of ESPB is that distribution of
      local anesthetic solution spreads into the para-vertebral space and epidural space, which
      then blocks the dorsal, ventral, and traffic branches of spinal nerve.

      ESPB, TPVB and QLB III have been shown to improve analgesic outcome after urological
      surgeries.
    

Intervention name(s): ESPB Technique; TPVB Technique; QLB Technique
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): The patient will be in sitting position. The probe will be positioned with longitudinal alignment, 3 cm lateral to the spinous procedure of T8 to obtain a parasagittal view. An echogenic needle will be introduced from the caudal end of the probe and advanced in-plane direction until the needle tip hit the tip of the transverse process. Bupivacaine will be afterwards injected into the erector spinae plane block. Linear spread cranially and caudally below the muscle upon injection will be visualized on the US screen indicating successful block.; The patient will be in sitting position. The probe will be positioned with longitudinal alignment, 3 cm lateral and parallel to 8th spinous process till transverse process, superior costotransverse ligament, and pleura will be visualized then lateral tilt of the probe was done for better visualization of the PVS between the superior costotransverse ligament and the pleura. An echogenic needle was introduced at caudal end of transducer using the in-plane technique till piercing the superior costotransverse ligament . Bupivacaine will be injected into the PVS with downward displacement of the pleura indicating a successful block.; The patient will be in lateral position. The probe will be placed above the iliac crest. The Petit's triangle will be identified. The three abdominal muscles (i.e., the external oblique, internal oblique and transversus abdominus muscles) will be detected. Both the external oblique and internal oblique muscles will be followed posteriorly until the layers of the thoracolumbar fascia appear as a bright hyperechogenic line. The quadratus lumborum muscle appears below to the latissimus dorsi muscle. While performing the quadratus lumborum block, "Shamrock sign" is identified; the transverse process of L4 appears as a stem whereas the three muscles psoas muscle, quadratus lumborum muscle and erector spinae appear as the leaves. A 22G (50mm) needle was inserted using an in-plane technique along the posterior edge of the ultrasound probe in the anteromedial direction. The needle tip was placed between the quadratus lumborum muscle and the Erector spinae muscle.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment