Quadratus Lumborum Block for Lumbar Spinal Surgery
Condition: Lumbar Disc Herniation
MeSH terms: Intervertebral Disc Displacement; Hernia
Study type: Interventional

Summary: 
      Spine surgery in thoracolumbar region is one of the most common surgeries performed for the
      treatment of leg and back pain. Pain management is especially important for these patients
      since chronic pain often occurs after surgery. Severe pain may occur at postoperative period
      in patients following lumbar disc herniation (LDH) operation. Postoperative effective pain
      treatment provides early mobilization and shorter hospital stay, thus complications due to
      hospitalization such as infection and thromboembolism may be reduced.

      Ultrasound-guided quadratus lumborum block (QLB) is a fascial plane block where local
      anesthetic is injected adjacent to the quadratus lumborum muscle with the goal of
      anesthetizing the thoracolumbar nerves.

      The aim of this study is to evaluate the efficacy of US-guided QLB for postoperative
      analgesia management after lumbar disc herniation-laminectomy surgery. The primary aim is to
      evaluate postoperative pain scores (VAS), the secondary aim is to evaluate use of rescue
      analgesia and adverse effects (allergic reaction, nausea, vomiting).
    

Detailed description: 
      Spine surgery in thoracolumbar region is one of the most common surgeries performed for the
      treatment of leg and back pain. Pain management is especially important for these patients
      since chronic pain often occurs after surgery. Severe pain may occur at postoperative period
      in patients following lumbar disc herniation (LDH) operation. Postoperative effective pain
      treatment provides early mobilization and shorter hospital stay, thus complications due to
      hospitalization such as infection and thromboembolism may be reduced.

      Opioids are one of the most preferred drugs among the analgesic agents. Parenteral opioids
      are generally performed for patients after surgery. However opioids have undesirable adverse
      events such as nausea, vomiting, itching, sedation and respiratory depression (opioid-related
      adverse events).

      Various methods may be performed to reduce the use of systemic opioids and for effective pain
      treatment. US-guided interfascial plane blocks have been used increasily due to the
      advantages of ultrasound in anesthesia practice. Ultrasound-guided quadratus lumborum block
      (QLB) is a fascial plane block where local anesthetic is injected adjacent to the quadratus
      lumborum muscle with the goal of anesthetizing the thoracolumbar nerves.

      The aim of this study is to evaluate the efficacy of US-guided QLB for postoperative
      analgesia management after lumbar disc herniation-laminectomy surgery. The primary aim is to
      evaluate postoperative pain scores (VAS), the secondary aim is to evaluate use of rescue
      analgesia and adverse effects (allergic reaction, nausea, vomiting).
    

Intervention name(s): Quadratus Lumborum Block
Intervention type(s): Drug
Intervention description(s): The block procedure will be applied after the surgery and before extubation with patients in the prone position by using US (Vivid Q, GE Healthcare, US). Under aseptic conditions using 10% povidone iodine, the convex probe will be covered with a sterile sheath and a 22G, 100 mm block needle (Braun Stimuplex Ultra 360, Germany) will be used. After visualizing the abdominal muscles with the anterior approach, the needle will be punctured in the Petit triangle and 5 ml of saline will be injected into the anterolateral border of the quadratus lumborum muscle. After the block location is confirmed, 15 ml of 0.25% bupivacaine will be injected. The same process will be applied to the opposite side (30 ml totally).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Ninety patients aged 18-65 years old with American Society of Anesthesiologists (ASA) classification I-II and scheduled for lumbar disc herniation surgery will be included in the study. Patients will be randomly divided into two groups (Group Q = QLB group, Group C = Control group) including 30 patients each, before entering the operating room.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Lumbar Disc Herniation; Postoperative pain management; Quadratus Lumborum Block