Comaprison Between QLB and ESPB in Patients for PCNL Operation

Study Overview
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Brief Summary
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comparing the subcostal oblique Quadratus Lumborum block and the Erector Spinae plane block in patients undergoing percutaneous nephrolithotomy operation to get the best and longest postoperative analgesic effect.

Detailed Description
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Here the investigators are going to compare between the Anterior approach for the subcostal oblique Quadratus Lumborum block (QLB) and the Erector Spinae Plane Block (ESPB) to determine their level of spread and their value in controlling postoperative pain in patients scheduled for Percutaneous Nephrolithotomy surgery. We hypothesized that quadratus lumborum is not inferior regarding the duration of analgesia when compared to erector spinae in patients undergoing percutaneous nephrolithotomy under general anesthesia.

Official Title
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Comparison Between Ultrasound Guided Subcostal Oblique Quadratus Lumborum Block and Erector Spinae Plane Block in Patients Undergoing Percutaneous Nephrolithotomy

Conditions
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Pain, Postoperative

Intervention / Treatment
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* Procedure: Subcostal Oblique Quadratus Lumborum Block and Erector Spinae Plain Block.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Both sex Age: 18-60 ASA (American Society of Anesthesiologists) class I and II Elective surgery Patients undergoing PNL surgery Exclusion Criteria: Patient's refusal Allergy or contraindications to drugs used in the study Emergency surgery Psychiatric disorders Severely co-morbid patients Inflammation or infection over injection site Bleeding diathesis; INR more than 1.5 and Platelet count less than 100,000/mm3 Peripheral neuropathy Obese patients BMI ≥35 Patients on previous opioid therapy Pre-operative haemoglobin <10 mg/dl Inability to properly describe postoperative pain to investigators Coagulation abnormalities History of drug addiction or alcohol abuse History of Previous renal surgery

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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Accepts Healthy Volunteers

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: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: QLB<br>The patient is in the prone position, an ultrasound probe is placed in a transverse, oblique, and paramedian orientation approximately lateral to the posterior axillary line. The needle is then inserted in-plane from the medial side of the transducer and advanced laterally to enter the interfascial plane between the Quadratus Lumborum muscle and the kidney. We confirmed that the local anesthetic appeared to press down the kidney in the ultrasound image | Procedure: Subcostal Oblique Quadratus Lumborum Block and Erector Spinae Plain Block.<br>* patients undergo general anesthesia,will be put in prone position.In case of Quadratus Lumborum block 1-3 mL of normal saline is injected to produce hydro-dissection and spread cranially between the QL and kidney. The corresponding ultrasonographic sign is a lunar-shaped hypo-echoic fluid collection observed between the long axis of the kidney and QL muscle. 20 ml Bupivacaine 0.5%, 10 ml Lidocaine 2%, and 10 ml normal saline is administered. In case of the ESPB The location of the needle tip is confirmed by hydro-dissection and after visualizing the fluid spread lifting the Erector Spinae off the transverse process, 20 ml bupivacaine 0.5%, 10 ml Lidocaine 2%, and 10 ml normal saline is injected.<br>|
| Active Comparator: ESPB<br>Using aseptic technique, an ultrasound probe is placed at the T9 vertebral level. After identifying the ribs and sliding towards the midline in a longitudinal parasagittal orientation, the overlying Erector Spinae is identified by visualization of the transition between the rib and transverse apophysis a block needle is inserted in plane with ultrasound beam and is advanced in a cephalo-caudal direction until the tip contacted the transverse process. | Procedure: Subcostal Oblique Quadratus Lumborum Block and Erector Spinae Plain Block.<br>* patients undergo general anesthesia,will be put in prone position.In case of Quadratus Lumborum block 1-3 mL of normal saline is injected to produce hydro-dissection and spread cranially between the QL and kidney. The corresponding ultrasonographic sign is a lunar-shaped hypo-echoic fluid collection observed between the long axis of the kidney and QL muscle. 20 ml Bupivacaine 0.5%, 10 ml Lidocaine 2%, and 10 ml normal saline is administered. In case of the ESPB The location of the needle tip is confirmed by hydro-dissection and after visualizing the fluid spread lifting the Erector Spinae off the transverse process, 20 ml bupivacaine 0.5%, 10 ml Lidocaine 2%, and 10 ml normal saline is injected.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Analgesia | Total opioid consumption during the first 48hours postoperatively. | 48 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Analgesia | first Analgesic request postoperatively. | 24 hours | 
| episodes of nausea and vomiting | to investigate if there is or not. | within 24 hours postoperative | 
| Pain Scores using Visual Analog Scale (VAS) Scores | VAS is a scale to determine the patient's pain level. | 24 hours postoperative. | 
| ambulation time | time from the end of the surgery to the first time to out-of-bed activity | 5 days postoperative | 
| time of recovery of bowl movement | time from the end of the surgery to the first time of bowl movement | 5 days postoperative | 
| patient satisfaction with anesthesia | Patient satisfaction with anesthesia was assessed using a 5-point scale (5: very satisfied; 4: satisfied; 3: neither satisfied nor dissatisfied; 2: dissatisfied; 1: very dissatisfied) | 48 hours postoperative. | 
| postoperative length of hospital stay | till time of discharge | within 2 weeks postoperative. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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QLB, pain management, Nephrolithotomy, ESPB, Erector Spinae, Quadratus Lumborum, Anesthesia, ultrasound, regional anethesia