Quadratus Lumborum Block for Percutaneous Nephrostomy

Study Overview
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Brief Summary
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Percutaneous nephrostomy (PCN) is one of the interventions in the radiology department in which pain control is necessary. Quadratus Lumborum (QL) block will be tried to limit the use of systemic analgesics and its accompanying untoward effects in those frail patients requiring PCN that is performed in the prone position.

Detailed Description
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Quadratus Lumborum block is a novel technique in which extension into the thoracic paravertebral space may occur. QL block would seem to be able to alleviate both somatic and visceral pain so it's expected to decrease the need for systemic sedation\analgesia to a minimum.

Official Title
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Quadratus Lumborum Block Versus Local Anesthetic Infiltration Combined With Monitored Anesthesia Care for Percutaneous Nephrostomy

Conditions
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Nephrostomy; Complications, Regional Anesthesia Morbidity, Upper Urinary Tract Dilatation and Obstruction, Adverse Anesthesia Outcome

Intervention / Treatment
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* Procedure: Local Anesthetic infiltration
* Procedure: Quadratus Lumborum block
* Drug: MAC


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA grade III and IV patients, Ureteral obstruction due to malignancy or secondary to urinary diversion after cystectomy Exclusion Criteria: Bleeding diathesis; INR more than than 1.5 and platelet count less than 100,000/mm3. Untreated urinary tract infection; Pre-operative haemoglobin <10 gm/dl, Severely co morbid patients Non-dilated renal collecting system Patient refusal to consent for the procedure.

Ages Eligible for Study
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Minimum Age: 18 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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Local Anesthetic infiltration and MAC<br>Local Anesthetic infiltration with 1% lignocaine MAC with IV Midazolam Img\ml and Fentanyl 10 mic\ml | Procedure: Local Anesthetic infiltration<br>* Lignocaine infiltration through the nephrostomy track<br>* Other names: Lignocaine;Drug: MAC<br>* Incremental doses are given to the targed sedation and analgesia<br>* Other names: -Fentanyl: 10 mic\ml;|
| Experimental: Quadratus Lumborum block and MAC<br>QL block with 0.25% levobupivacaine (Chirocaine, Abbott, Ireland) and 1% lignocaine MAC with IV Midazolam Img\ml and Fentanyl 10 mic\ml | Procedure: Quadratus Lumborum block<br>* A linear 12-MHz ultrasound probe will be placed in the anterior axillary line to visualize the typical triple abdominal layers. Then, the probe will be placed in the midaxillary line and at this point the layers of abdominal layers starte to taper. The probe will be placed in the posterior axillary line, sonoanatomy will show first the transversus abdominis disappearing then the internal oblique and external oblique forming aponeurosis and appearance of QL will be noticed. At the posterior border of the quadratus lumborum muscle and outside the fascia, Touhe needle will be inserted in plane and confirmed its position by injecting saline. Under ultrasound (US) guidance, local anesthetic mixure will be deposited separating the fascia<br>* Other names: -1% lignocaine;Drug: MAC<br>* Incremental doses are given to the targed sedation and analgesia<br>* Other names: -Fentanyl: 10 mic\ml;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Analgesia | Verbal Rating Scale is assessed for degree of pain during the procedure and after till discharge from the radiology department. | 4 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Respiratory Depression | Respiratory rate and airway patency is monitored with an anesthesiologist. | 4 hours | 
| Sedation | Ramsay Seadation Score is assessed during and after procedure till discharge | 4 hours | 
| Cardiovascular stability | Blood pressure and Heart rate is assessed during and after procedure till discharge | 4 hours | 
| Patient Satisfaction | Patient Satisfaction Quistionaire | 48 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Percutaneous Nephrostomy, Quadtatus Lumborum Block, Cancer, Monitored Anaesthesia Care