Comparison of Quadratus Lumborum Block With TAP Block for Postoperative Analgesia After Laparoscopic Nephrectomy

Study Overview
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Brief Summary
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This is a randomised controlled trial which will compare the Quadratus Lumborum (QL) Block with the Transversus Abdominis Plane (TAP) Block in terms of analgesic efficacy, ease of performance and safety when administered postoperatively in patients who undergo laparoscopic nephrectomy. To fulfill this purpose, three groups of patients each with 32 patients, will be formed. Patients in the Transversus Abdominis Plane (TAP) group and Quadratus Lumborum (QL) group will each receive the respective blocks with 0.4 ml/kg of 0.25% Bupivacaine, after completion of surgery. The third (Control group) will not receive any blocks. After shifting patients to recovery all three groups will be put into intravenous patient controlled analgesia (PCA) Morphine as rescue analgesic regimen as per a set protocol. Morphine consumption over the first postoperative 24 hours, ease of performance of individual blocks and associated adverse events, adverse events associated with opioid use, patient recovery and satisfaction will be noted.

Official Title
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Comparison of Ultrasound Guided Quadratus Lumborum Block With Ultrasound Guided TAP Block for Postoperative Analgesia After Laparoscopic Nephrectomy: a Prospective Randomized Controlled Trial

Conditions
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Postoperative Pain

Intervention / Treatment
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* Other: Transversus Abdominis Plane (TAP) Block
* Other: Quadratus Lumborum (QL) Block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients between 18-65 years of age, ASA class I or II, undergoing elective unilateral laparoscopic nephrectomy under general anaesthesia Exclusion Criteria: Patients with any of the following: refusal to participate in the study coagulopathy/ thrombocytopenia localised infection at the proposed site of injection inability to comprehend the scoring systems to be employed or use PCA due to physical or mental problems known allergy to the drugs to be used (local anesthetics, opioids) opioid tolerance/ dependence renal impairment hepatic impairment known cardio-respiratory impairment morbid obesity/ sleep apnoea

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 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: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Transversus Abdominis Plane group<br> | Other: Transversus Abdominis Plane (TAP) Block<br>* 0.5 ml/kg of 0.25 % Bupivacaine deposited in the transversus abdominis plane under ultrasound guidance postoperatively<br>|
| Experimental: Quadratus Lumborum group<br> | Other: Quadratus Lumborum (QL) Block<br>* 0.5 ml/kg of 0.25 % Bupivacaine deposited in the anterolateral aspect of the quadratus lumborum muscle under ultrasound guidance postoperatively<br>|
| No Intervention: Control group<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cumulative morphine consumption in 24 hours in milligrams |  | within the first 24 hours after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain scores at rest and on movement as measured by numeric rating scale (0 to 10) |  | within the first 24 hours after surgery | 
| Time to first demand of rescue analgesic in hours |  | within the first 24 hours after surgery | 
| Ease of performing the respective blocks (assessed by time required to perform the blocks in minutes and number of attempts required to perform the blocks) |  | while performing block | 
| Incidence of block related complications |  | within the first 24 hours after surgery | 
| Incidence of adverse effects related to opioid use (derrived from incidence of nausea and vomiting, sedation and respiratory depression) |  | within the first 24 hours after surgery | 
| Patient satisfaction as measured by numeric rating scale (0 to 10) |  | 24 hours after surgery |