Bilateral Ultrasound Guided Quadratus Lumborum Versus Lumbar Epidural Block on Postoperative Analgesia, and Inflammatory Response in Abdominal Surgery

Study Overview
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Brief Summary
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This study aims at comparing the effects of bilateral ultrasound-guided quadratus lumborum block versus lumbar epidural block on postoperative analgesia and inflammatory response following major lower abdominal cancer surgery.

Official Title
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Effect of Bilateral Ultrasound Guided Quadratus Lumborum Block Versus Lumbar Epidural Block on Postoperative Analgesia, and Inflammatory Response Following Major Lower Abdominal Cancer Surgery

Conditions
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Postoperative Pain, Inflammatory Response

Intervention / Treatment
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* Other: Ultrasound quadratus lumborum block with bupivacaine 25%
* Other: lumbar epideural block with bupivacaine 25%


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA II, III Weight 50 - 85 kg. Scheduled for major lower abdominal cancer surgery (radical cystectomy, total abdominal hysterectomy). Exclusion Criteria: Patients with a history of relevant drug allergy. Coagulation disorders. Opioid dependence. Sepsis. Local infection at the vicinity of the block site. Patients with psychiatric illnesses that would interfere with perception and assessment of pain

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 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: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: quadratus lumborum block<br>received pre-emptive ultrasound-guided quadratus lumborum block with 25 mL of 0.25% bupivacaine on each side of the abdominal wall before induction of GA. | Other: Ultrasound quadratus lumborum block with bupivacaine 25%<br>* echogenic needle will be inserted in-plane with the ultrasound beam in a posterior-to-anterior direction through the quadratus lumborum muscle until the ventral fascia of the muscle penetrated. At this point, the needle directed toward the fascial plan between the quadratus lumborum and the Psoas muscle<br>|
| Active Comparator: lumbar epideural block<br>received pre-emptive lumbar epidural block with 15 mL of 0.25% bupivacaine before induction of GA. | Other: lumbar epideural block with bupivacaine 25%<br>* lumbar epidural will be performed for patients in group II using a 16-gauge Touhy epidural needle by a median approach. The T12 - L1 or L1 - L2 interspaces will be chosen for the injection. The epidural space identified by the loss of resistance technique.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative pain | postoperative pain intensity. | first 24 hours postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postoperative inflammatory response | inflammatory response represented by the levels of: interleukins 1,6, and tumor necrosis factor alpha | first 24 hours postoperatively | 
| side effects | sedation, nausea, vomiting, and respiratory depression | first 24 hours postoperatively |