Comparison of Two Techniques of Quadratus Lumborum Block

Study Overview
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Brief Summary
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Our objective is to investigate the extent of cranial dermatomal spread of transmuscular quadratus lumborum block(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.

Detailed Description
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The paramedian sagittal oblique transmuscular quadratus lumborum block(TMQLB )approach has been introduced to facilitate cranial spread by injecting the local in a caudal to cranial direction compared with the transverse approach. Currently, there are no data comparing the two techniques mentioned above with regards to extent of spread level. 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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Transverse Versus Longitudinal Technique of Ultrasound-Guided Transmuscular Quadratus Lumborum Block:A Randomized Controlled Study Comparing Dermatomal Spread

Conditions
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Nerve Block

Intervention / Treatment
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* Procedure: transverse scan, in-plane, posterior- anterior quadratus lumborum block
* Procedure: paramedian sagittal longitudinal scan, in-plane, caudal-cranial quadratus lumborum block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ≥Age 18yrs American Society of Anesthesiologists physical status I-II 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

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 quadratus lumborum block<br>The patients will receive the transmuscular quadratus lumborum block before surgery using the transverse scan, in-plain, posterior to anterior approach. 0.6ml/kg 0.375% ropivacaine is injected when the correct needle location is confirmed. | Procedure: transverse scan, in-plane, posterior- anterior quadratus lumborum block<br>* transverse scan, in-plane, posterior- anterior quadratus lumborum block The patients will receive the transmuscular quadratus lumborum block before surgery using the transverse scan, in-plain, posterior to anterior approach. 0.6ml/kg 0.375% ropivacaine is injected when the correct needle location is confirmed.<br>* Other names: drug:ropivacaine;|
| Experimental: longitudinal quadratus lumborum block<br>The patients will receive the transmuscular quadratus lumborum block before surgery using the paramedic sagittal longitudinal scan, in-plain, caudal-cephalic approach.0.6ml/kg 0.375% ropivacaine is injected when the correct needle location is confirmed. | Procedure: paramedian sagittal longitudinal scan, in-plane, caudal-cranial quadratus lumborum block<br>* The patients will receive the transmuscular quadratus lumborum block before surgery using the paramedic sagittal longitudinal scan, in-plain, caudal-cephalic approach.0.6ml/kg 0.375% ropivacaine is injected when the correct needle location is confirmed.<br>* Other names: drug:ropivacaine;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cephalic sensory dermatomal spread | The pinprick method at the midclavicular line was used to assess the extent of the dermatomal blockade, 20 minutes following the completion of the procedure by a person who was blinded to group allocation. The most cephalic dermatomal level that show a decreased pinprick sensation is recorded.A block failure was defined as the absence of any demonstrable sensory block 20 minutes after performance of the block. | 20 minutes after block performance] | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to performance of procedure | Duration from needle insertion toward local anesthetic injection finished | Duration of procedure | 
| Total sensory dermatomal spread | The pinprick method at the midclavicular line was used to assess the extent of the dermatomal blockade, 20 minutes following the completion of the procedure by a person who was blinded to group allocation. The total number of dermatomal levels that show decreased pinprick sensation is recorded.A block failure was defined as the absence of any demonstrable sensory block 20 minutes after performance of the block. | 20 minutes after block performance | 
| Incidence of complication | incidence of complication including bleeding, hematoma, infection at puncture site, local anesthetic poisoning, etc | Within 48 hours after surgery | 
| Caudal sensory dermatomal spread | The pinprick method at the midclavicular line was used to assess the extent of the dermatomal blockade, 20 minutes following the completion of the procedure by a person who was blinded to group allocation. The most caudal dermatomal level that show a decreased pinprick sensation is recorded.A block failure was defined as the absence of any demonstrable sensory block 20 minutes after performance of the block. | 20 minutes after block performance | 
| rescue analgesics usage | NSAIDs or opioids used for pain relief and their dosage | At 0,12,24,48 hours after surgery |