U/S-guided Continuous Quadratus Lumborum Block III in Percutaneous Nephrolithotomy

Study Overview
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Brief Summary
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Percutaneous nephrolithotomy (PCNL) is considered to be the first choice and a more conservative procedure than open stone surgery. Not only postoperative pain related to dilatation of the renal capsule and parenchymal tract, but also patient's discomfort & nephrostomy tube-related stress are reported to delay recovery time and increase the complication rates. This study is designed to provide postoperative analgesia by using ultrasound-guided continuous Quadratus Lumborum Block (QLB) III in patients undergoing PCNL and to assess pain scores & side effects with less opioids consumption.

Official Title
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Ultrasound-guided Continuous Quadratus Lumborum Block III for Postoperative Analgesia in Percutaneous Nephrolithotomy

Conditions
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Analgesia, Surgery, Renal Stone

Intervention / Treatment
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* Procedure: Continous Quadratum Lumborum Block III
* Procedure: Single dose Quadratum Lumborum Block III
* Procedure: Intra-venous Morphine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA I-II. Scheduled for percutaneous nephrolithotomy (PCNL). Exclusion Criteria: Patient refusal. Coagulation disorders. Skin lesions or infection at site of needle insertion. Known allergy to local anesthetics or opioids. Patients suffering from neurological or mental disease. Procedure turned into open stone surgery. Failure of identification by U/S. Urinary tract malignancies. Opioid consumption 48 hours before the operation.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Continuous QLB group<br>U/S-guided continous QLB III | Procedure: Continous Quadratum Lumborum Block III<br>* Continuous infusion of Bupivacaine 0.125 % at a rate of 0.1 ml/kg/hr (not exceeding 12 ml/hour), infused through a catheter inserted in the plane between quadratus lumborum & psoas major muscles with ultrasound guidance.<br>Procedure: Single dose Quadratum Lumborum Block III<br>* Single injection of a mixture solution of 20 ml Bupivacaine 0.5% + 10 ml Lidocaine 2%, injected through a needle inserted at the posterior aspect of the quadratus lumborum muscle between it and erector spinae muscle with ultrasound guidance.<br>Procedure: Intra-venous Morphine<br>* Intra-venous Morphine [0.1 mg/kg] as rescue analgesic shots when the Visual Analogue Score (VAS) for pain exceeds 4.<br>|
| Active Comparator: Single dose QLB group<br>U/S-guided single dose QLB III | Procedure: Single dose Quadratum Lumborum Block III<br>* Single injection of a mixture solution of 20 ml Bupivacaine 0.5% + 10 ml Lidocaine 2%, injected through a needle inserted at the posterior aspect of the quadratus lumborum muscle between it and erector spinae muscle with ultrasound guidance.<br>Procedure: Intra-venous Morphine<br>* Intra-venous Morphine [0.1 mg/kg] as rescue analgesic shots when the Visual Analogue Score (VAS) for pain exceeds 4.<br>|
| Active Comparator: Morphine group<br>IV Morphine | Procedure: Intra-venous Morphine<br>* Intra-venous Morphine [0.1 mg/kg] as rescue analgesic shots when the Visual Analogue Score (VAS) for pain exceeds 4.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Morphine consumption. | Total dose of Morphine (measured in mg) given intra-venously to the patient post-operatively. | 24 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Quadratus Lumborum Block III, Ultrasound-guided, Percutaneous nephrolithotomy, Analgesia