Clinical trial NCT05822492: Anterior Quadratus Lumborum Block Versus Erector Spina Plane Block in Percutaneous Nephrolithotomy Surgery
Official title: Comparison of the Effects of Anterior Quadratus Lumborum Block and Erector Spina Plane Block on Postoperative Acute Pain in Percutaneous Nephrolithotomy Surgery
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Anesthesia
Analgesia
Patient Controlled Analgesia
Quadratus Lumborum Block
Erector Spina Plane Block
Keywords: Anesthesia
Analgesia
Percutaneous Nephrolithotomy Surgery
Patient controlled analgesia
Anterior quadratus lumborum block
Erector spina plane block
Lead sponsor: Ondokuz Mayıs University
Sponsor class: OTHER
First posted: 2023-04-20
Enrollment: 90
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients with undergoing percutaneous nephrolithotomy surgery,

Brief summary: In this study, it was aimed to evaluate the effects of anterior quadratus lumborum block (QLB3) and Erector Spina Plane Block (ESPB) on postoperative acute pain scores and opioid consumption in the first 24 hours in Percutaneous Nephrolithotomy Surgery

Detailed description: Percutaneous nephrolithotomy (PCNL) is commonly used to treat large kidney stones. Patients usually complain of severe pain and discomfort postoperatively. Postoperative pain prolongs hospital stay, delays wound healing, increases infection rates, and increases the incidence of drug side effects.

Regional anesthesia is part of multimodal analgesia in treating postoperative pain. Facial plane blocks are among these procedures. Erector spina plane block (ESPB) is a peri-paravertebral regional anesthesia technique applied for the first time to treat thoracic neuropathic pain. In the literature, the effectiveness of upper abdomen and renal operations in pain management has been demonstrated. Quadratus lumborum block (QLB) was first described as an alternative to the transversus abdominis plane block. This block can be performed with three methods under ultrasound guidance. An anterior QLB (QLB3) block was used in this study. In this block, the local anesthetic drug is applied between the quadratus lumborum muscle and the psoas muscle fascia and spreads along the thoracolumbar fascia. This block provides anesthesia and analgesia in the T7-L1 dermatome area. QLB3 block has been applied in pyeloplasty, cholecystectomy, lower abdominal surgeries, cesarean sections, radical nephrectomy, and hip joint surgeries and provided adequate postoperative analgesia.

This study aimed to evaluate the effects of QLB3 block and ESPB block on pain scores and opioid consumption in patients undergoing PCNL.

Patients will be divided into three groups.

Group QLB3:

Patients who applied the OLB3 block and IV morphine-patient-controlled analgesia (PCA) before PCNL surgery were included in this group.

Group ESPB:

Patients who applied ESPB block and IV morphine-PCA before PCNL surgery were included in this group.

Group Control In this group, patients only applied general anesthesia and IV morphine-PCA.

Eligibility criteria: Inclusion Criteria:

* 18-65 years
* American Society of Anesthesiology score I-III patients scheduled for unilateral PCNL in elective conditions
* Patients with BMI \<35 kg/m2

Exclusion Criteria:

* Pregnancy
* Conditions where regional anesthesia is contraindicated (coagulopathy, international normalized ratio abnormality, thrombocytopenia, infection at the injection site)
* History of hypersensitivity or allergy to local anesthetics
* Patients with psychiatric disorders
* Patients with musculoskeletal deformities
* Patients with alcohol-drug dependence
* Patients with cognitive dysfunction (patients incapable of evaluating the NRS score)
* Patients who did not give consent / did not want to participate

Primary outcomes:
measure: Morphine consumption in the first 24 hours after surgery
timeFrame: postoperative day 1
Secondary outcomes:
measure: Postoperative pain scores
timeFrame: postoperative day 1
measure: The postoperative nausea and vomiting (PONV) scores and the number of patients requiring antiemetic medication.
timeFrame: postoperative day 1
measure: Intraoperative remifentanil consumption
timeFrame: The remifentanil consumption will be recorded from anesthesia induction until the patient is referred to the recovery unit, up to 150 minutes.
measure: The number of patient required rescue analgesia
timeFrame: postoperative day 1
measure: Time of first analgesic request
timeFrame: postoperative day 1
measure: The number of patients with complications
timeFrame: Postoperative 7 days on an average
measure: The mean arterial pressure
timeFrame: The mean arterial pressure was recorded preoperatively, one minute after the induction, and every 15-30 minutes until the patient was referred to the recovery unit, up to 180 minutes.
measure: The heart rate measurement
timeFrame: The heart rate was recorded preoperatively, one minute after the induction, and every 15-30 minutes until the patient was referred to the recovery unit, up to 180 minutes.
Other outcomes:
Locations:
city: Samsun
country: Turkey
facility: Ondokuz mayıs Universty
Study officials:
affiliation: Ondokuz Mayıs University
name: CENGIZ KAYA
role: STUDY_DIRECTOR
References:
citation: Dam M, Hansen CK, Poulsen TD, Azawi NH, Wolmarans M, Chan V, Laier GH, Bendtsen TF, Borglum J. Transmuscular quadratus lumborum block for percutaneous nephrolithotomy reduces opioid consumption and speeds ambulation and discharge from hospital: a single centre randomised controlled trial. Br J Anaesth. 2019 Aug;123(2):e350-e358. doi: 10.1016/j.bja.2019.04.054. Epub 2019 May 30.
citation: Dam M, Moriggl B, Hansen CK, Hoermann R, Bendtsen TF, Borglum J. The Pathway of Injectate Spread With the Transmuscular Quadratus Lumborum Block: A Cadaver Study. Anesth Analg. 2017 Jul;125(1):303-312. doi: 10.1213/ANE.0000000000001922.
citation: De Cassai A, Bonvicini D, Correale C, Sandei L, Tulgar S, Tonetti T. Erector spinae plane block: a systematic qualitative review. Minerva Anestesiol. 2019 Mar;85(3):308-319. doi: 10.23736/S0375-9393.18.13341-4. Epub 2019 Jan 4.
citation: Elsharkawy H. Quadratus Lumborum Blocks. Adv Anesth. 2017;35(1):145-157. doi: 10.1016/j.aan.2017.07.007. Epub 2017 Oct 3. No abstract available.
citation: Kilic E, Bulut E. Quadratus Lumborum Block III for Postoperative Pain After Percutaneous Nephrolithotomy. Turk J Anaesthesiol Reanim. 2018 Aug;46(4):272-275. doi: 10.5152/TJAR.2018.92331. Epub 2018 Aug 1.