Analgesic Efficacy of Transmuscular Quadratus Lumborum in Patients Undergoing Total Abdominal Hysterectomy

Study Overview
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Brief Summary
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Patients who have undergone laparotomies often require multimodal postoperative pain regimes. In recent years, abdominal wall blocks have been included to become part of this in order to overcome side effects of systemic opioids and complications from epidural analgesia. Borglum popularised a new approach on abdominal wall blocks by introducing the transmuscular quadratus lumborum (QL) block. Transmuscular QL block is thought to be effective against somatic and visceral pain as local anaesthetic tends to spread from the site of injection to thoracic paravertebral spaces where the sympathetic chain lies. The objective of this study is to evaluate the analgesic efficacy of transmuscular QL block in patients undergoing total abdominal hysterectomy (TAH) by measuring cumulative opioid consumption, pain score at rest and on movement 24 hours after TAH. Our hypothesis is patients given transmuscular QL block will have lower cumulative opioid consumption.

Official Title
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Transmuscular Quadratus Lumborum Block for Postoperative Pain After Total Abdominal Hysterectomy

Conditions
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Pain Postoperative

Intervention / Treatment
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* Procedure: Transmuscular quadratus lumborum block
* Drug: morphine
* Drug: ropivacaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA I or II Patient's weight > 50kg Elective TAH Exclusion Criteria: Body mass index (BMI) > 35 kg/m2 Any contraindications to peripheral nerve blocks i.e. local skin infection, coagulopathy, allergy to LA Inability to use patient controlled analgesia Patient on antiplatelet, anticoagulant or on regular use of opioids, paracetamol, nonsteroidal anti-inflammatory drugs or tramadol for chronic condition

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Female

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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Transmuscular quadratus lumborum (QL) block<br>Bilateral QL block using 20 ml 0.375% ropivacaine in each side (to a maximum dose 3 mg/kg) plus patient controlled analgesia morphine (1mg/bolus morphine, lockout time 5 minutes) post operative | Procedure: Transmuscular quadratus lumborum block<br> <br> Drug: morphine<br> <br> Drug: ropivacaine<br> <br> |
| Active Comparator: Control<br>Patient controlled analgesia morphine (1mg/bolus morphine, lockout time 5 minutes) post operative | Drug: morphine<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cumulative morphine consumption | in mg for 24 hours | 24 hours after total abdominal hysterectomy | 
| Pain score at rest and movement | using visual analogue scale 1 to 10 | 24 hours after total abdominal hysterectomy | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Complications related to the transmuscular QL block | Complications related to transmuscular QL block: Haematoma at site of injection,infection at site of injection Complications related to PCAM:Nausea, vomiting, pruritus, sedation | 24 hours after total abdominal hysterectomy | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Transmuscular quadratus lumborum block, total abdominal hysterectomy