Modified Paramedic Sagittal vs. Transverse TMQLB

Study Overview
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Brief Summary
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The classical transmuscular qudratus lumborum block(TMQLB) described by Borglum aims to provide lower thoracic paravertebral space(PVS) and sympathetic blockade by injecting local anesthetics between QL and PM muscle at the L3-L4 vertebral level using a transverse scan, posterior-anterior, in-plane approach. Recently, a paramedian sagittal oblique(TMQLB) approach has been introduced to facilitate cranial spread by injecting the local in a caudal to cranial direction. Currently, there are no data comparing the two techniques mentioned above with regards to extent of spread for PVS. Our objective is to investigate the extent of cranial dermatomal spread of TMQLB when equal dosage(ml/kg) of local anesthetic are injected with the transverse versus an modified paramedian sagittal approach for patients undergoing laparoscopic adrenalectomy. In addition, the investigators wish to compare the performance time, caudal dermatomal spread of TMQLB and postoperative analgesia effect.

Official Title
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Randomized Prospective Study to Evaluate Cranial Dermatomal Spread of Modified Paramedic Sagittal Versus Transverse Approach TMQLB for Adrenal Surgery

Conditions
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Nerve Block

Intervention / Treatment
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* Procedure: transverse scan, in-plane, posterior-anterior TMQLB
* Procedure: paramedian sagittal scan, in-plane, caudal-cranial TMQLB


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18-70 yrs American Society of Anesthesiologists physical statusⅠ-Ⅲ Undergo laparoscopic adrenalectomy Informed consent Able to cooperate with study process Exclusion Criteria: Allergy to local anesthetic and other medications used in the study Patient refusal or lack of informed consent Coexisting hematological disorder or with deranged coagulation parameters Pre-existing major organ dysfunction such as hepatic and renal failure History of previous renal surgery.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 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: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: transverse TMQLB<br>Patients in this group will receive the transmuscular quadratus lumborum block before surgery using the transverse scan, in-plain, posterior to anterior approach. 0.6ml 0.375% ropivocaine was injected when the correct needle location is confirmed. | Procedure: transverse scan, in-plane, posterior-anterior TMQLB<br>* The patients will receive the transmuscular quadratus lumborum block(TMQLB) before surgery using the transverse scan, in-plain, posterior to anterior approach. 0.6ml/kg 0.375% ropivocaine is injected when the correct needle location is confirmed.<br>|
| Experimental: paramedian sagittal TMQLB<br>Patients in this group will receive the transmuscular quadratus lumborum block before surgery using the para-sagittal scan, in-plain, caudal to cephalic approach.0.6ml 0.375% ropivocaine was injected when the correct needle location is confirmed. | Procedure: paramedian sagittal scan, in-plane, caudal-cranial TMQLB<br>* The patients will receive the transmuscular quadratus lumborum block(TMQLB) before surgery using the paramedic sagittal scan, in-plain, caudal-cephalic approach.0.6ml/kg 0.375% ropivocaine is injected when the correct needle location is confirmed.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cephalic sensory dermatomal spread |  | 20 minutes after block performance | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to performance of procedure |  | Duration of procedure | 
| Total sensory dermatomal spread |  | 20 minutes after block performance | 
| Incidence of complication |  | Within 48hours after surgery | 
| Caudal sensory dermatomal spread |  | 20 minutes after block performance | 
| cumulative rate of rescue analgesics usage |  | At 0,2,4,8,12,24,48 hours after surgery | 
| NRS pain scores | patients will evaluate their pain intensity with the numerical rating scale (NRS), where 0 indicates no pain, and 10 indicates the most severe pain. | At 0,2,4,8,12,24,48hours after surgery |