QLB Versus PVB for Acute Pain and Quality of Recovery After Laparoscopic Partial Nephrectomy

Study Overview
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Brief Summary
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This trial is a prospective, randomized, single-center, open-label, parallel-arm, blinded-analysis trial, the objective of which is to evaluate the effect of transmuscular quadratus lumborum block (TMQLB) in the pain relief and quality of recovery in laparoscopic partial nephrectomy compared with thoracic paravertebral block (TPVB).

Official Title
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Transmuscular Quadratus Lumborum Block Versus Thoracic Paravertebral Block for Acute Pain and Quality of Recovery After Laparoscopic Partial Nephrectomy

Conditions
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Nerve Block, Nephrectomy, Analgesia

Intervention / Treatment
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* Procedure: preoperative single-shot TMQLB
* Procedure: preoperative single-shot TPVB
* Drug: patient controlled intravenous analgesia(PCIA)


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 nephrectomy Informed consent Exclusion Criteria: A known allergy to the drugs being used Coagulopathy, on anticoagulants Analgesics intake, history of substance abuse Participating in the investigation of another experimental agent Inability to properly describe postoperative pain to investigators (eg, language barrier, neuropsychiatric disorder)

Ages Eligible for Study
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Minimum Age: 17 Years
Maximum Age: 80 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: TMQLB group<br> | Procedure: preoperative single-shot TMQLB<br>* The patient is placed in the lateral position. The curved probe of Ultrasound Scanner is used for scan and located vertical to the iliac crest at the posterior axillary line to find the Shamrock sign. The 22-G needle is then inserted in plane and directed to the QL muscle. After the proper position of the needle tip between the psoas major muscle and the quadratus lumborum muscle is confirmed, 0. 6 ml/kg 0.5% ropivacaine is injected into the interfascial plane. Followed by IPCA in the first 48h after surgery: morphine boluses: 1.5-2 mg, lockout time :10 min, 1h limitation: 6-8 mg morphine.<br>Drug: patient controlled intravenous analgesia(PCIA)<br>* at the end of surgery, patient is administered a PCIA with morphine boluses: 1.5-2 mg, lockout time :10 min, 1h limitation: 6-8 mg morphine.<br>|
| Active Comparator: TPVB group<br> | Procedure: preoperative single-shot TPVB<br>* The patient is placed in the lateral position, the spinous processes of T10 are identified and marks are made 2cm lateral to the spinous processes. The curve probe of ultrasound scanner is placed transversally at the mark to identify the paravertebral space. Then a 22-G needle is inserted in-plane from lateral to medial and advanced until the tip reached the paravertebral space surrounded by the parietal pleura and the superior costotransverse ligament. 0.4 ml/kg 0.5% ropivacaine is injected into the paravertebral space of T10.<br>Drug: patient controlled intravenous analgesia(PCIA)<br>* at the end of surgery, patient is administered a PCIA with morphine boluses: 1.5-2 mg, lockout time :10 min, 1h limitation: 6-8 mg morphine.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| cumulative morphine consumption |  | within 48 postoperative hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The pain scores determined by the numeric rating scale (NRS, 0-10) | NRS is an internationally recognized pain scale with 11 points ranging from 0 to 10 points, with 0 defined as no pain and 10 defined as the worst pain imaginable. | within 48 postoperative hours | 
| dermatomal distribution of sensory reduction | Thirty minutes after the block, the bilateral dermatomal sensory blocks for the anterior abdomen (between the anterior axillary and mid-clavicular lines) and thigh were assessed with the pinprick method. A reduce in pinprick sensation relative to the unblocked side was interpreted as an effective block. | 30 min after the block | 
| quality of recovery evaluated by the self-assessment 15-item quality of recovery (QoR) scale | QoR is a 15-item questionnaire which will score on a scale of 0-10 pertaining to patient's comfort, support system, pain, well-being, and ability to carry out daily activities, where 0 indicates none of the time and 10 indicates all of the time | at 3 days and 5 days after the sugery | 
| postoperative length of hospital stay | time to patient's discharge | within 2 weeks after the surgery | 
| patient satisfaction with anesthesia | use the Chinese version Bauer questionnaire to assess the patient satisfaction with anesthesia | 48 hours after surgery | 
| nausea and vomiting episodes |  | within 24 hours after the surgery] | 
| ambulation time | time from the end of the surgery to the first time to out-of-bed activity | within the 5 days after surgery | 
| time of recovery of bowl movement |  | within the 5 days after surgery |