Clinical trial NCT05713643: ESPB vs PVB vs QLB After Pelvi-ureteric Surgeries
Official title: Erector Spinae Plane Block Versus Paravertebral Block Versus Quadratus Lumborum Block on Postoperative Analgesia After Pelvi-ureteric Surgeries: A Randomized Double-Blinded, Non-inferiority Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Erector Spinae Plane Block
Paravertebral Block
Quadratus Lumborum Block
Analgesia
Lead sponsor: Kafrelsheikh University
Sponsor class: OTHER
First posted: 2023-02-06
Enrollment: 90
Sex: ALL
Minimum age (years): 21
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The aim of this study is to compare the analgesic efficacy of erector spinae plane block versus thoracic paravertebral block versus quadratus lumborum block on postoperative analgesia after pelvi-ureteric surgeries.

Detailed description: Opioid-based analgesia plays a significant role in the control of postsurgical pain; however, use of opioid may lead to significant side effects (e.g., nausea and vomiting) and adverse events (e.g. respiratory depression), which may be associated with significantly longer hospital stays and higher hospital costs in the postsurgical setting .

Thoracic paravertebral block (TPVB) is a classic trunk block with definite analgesic effect for both somatic and visceral pain.

Quadratus Lumborum block (QLB) is a widely used regional anesthesia technique as well. It has been used for reducing postoperative pain after cesarean section, laparotomy or laparoscopic procedure and hip surgery.

Erector spinae plane block (ESPB) is a novel inter-fascial plane block first introduced by Forero et al. in 2016 , providing wide-ranging analgesia in lung surgery, laparoscopy, mastectomy, and pediatric surgery. The proposed mechanism of ESPB is that distribution of local anesthetic solution spreads into the para-vertebral space and epidural space, which then blocks the dorsal, ventral, and traffic branches of spinal nerve.

ESPB, TPVB and QLB III have been shown to improve analgesic outcome after urological surgeries.

Eligibility criteria: Inclusion Criteria:

* Age 18-65 years
* Both genders
* American Society of Anesthesiologists (ASA) physical status I-III
* Undergoing elective pelvi-ureteric surgeries.

Exclusion Criteria:

* Body Mass Index \> 30 kg/m2.
* Contraindication of deep nerve block such as allergic to anesthetic drug, coagulation disorder, and infection at the injection site.
* Chronic opioids dependence or chronic pain over 3 months.
* Use of medication such as gabapentin-pregabalin could affect pain perception.
* Unable to communicate preoperatively due to severe dementia, language barrier, or neuropsychiatric disorder.
* Unable to perform nerve block procedure due to difficult anatomy through ultrasound scan.

Primary outcomes:
measure: The total postoperative morphine consumption
timeFrame: 48 hours postoperatively
Secondary outcomes:
measure: Access post-operative pain scores
timeFrame: 48 hours Postoperatively
measure: Access time of first analgesic
timeFrame: 48 hours Postoperatively
measure: Patients' satisfaction after surgery.
timeFrame: 48 hours Postoperatively
Other outcomes:
Locations:
city: Tanta
country: Egypt
facility: Mohammad Fouad Algyar
state: ElGharbiaa
Study officials:
References: