Clinical trial NCT05860309: Preoperative Versus Postoperative Quadratous Lunborum Block in Nephrectomy
Official title: Preoperative Versus Postoperative Ultrasound Guided Quadratous Lunborum Block for Postoperative Analgesia Following Open Nephrectomy, Acomparative Study
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Regional Blocks
Renal Surgery
Keywords: multimodal analgesia, regional blocks, renal surgeries
Lead sponsor: Ain Shams University
Sponsor class: OTHER
First posted: 2023-05-16
Enrollment: 100
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: preoperative versus postoperative quadratous lumborum block in nephrectomy
Primary purpose: TREATMENT

Brief summary: A multimodal analgesia regimen is suggested after nephrectomy, although some patients still report agonising pain. Regional anesthesia approaches may improve postoperative pain management and reduce the requirement for opioids after renal surgery.QLB provides early and rapid pain relief

Detailed description: In the immediate postoperative period, nerve blocks are considered a type of multimodal analgesia and have recently been proposed as analgesic options for patients undergoing open nephrectomy .

Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. The main barrier to early postoperative ambulation is postoperative pain, which also lengthens hospital stays and raises the risk of respiratory problems and venous thromboembolism. Therefore, strict perioperative pain management can have both immediate and long-term advantages .

QLB provides early and rapid pain relief and allows early ambulation in certain patient populations. Multiple case studies also confirmed the QLB to be a rescue block after different surgical procedures. Complications associated with the performance of abdominal wall blocks are fortunately very rare. However, studies on the effect of anterior QLB on postoperative opioid consumption are scarce .

Regional anesthesia is quickly moving toward using ultrasound guidance as the gold standard. The use of ultrasound has significant advantages over traditional treatments such as nerve stimulation and loss of resistance. The improved safety and efficacy that ultrasound brings to regional anaesthesia will help promote its use and realise the benefits that regional anaesthesia has over general anaesthesia, such as decreased morbidity and mortality, superior postoperative analgesia, cost-effectiveness, decreased postoperative complications and an improved postoperative course .

The aim of the present study is to compare the effectiveness of ultrasound-guided preoperative to postoperative QLB on the postoperative pain scores after Radical nephrectomy.

Eligibility criteria: Inclusion Criteria:

* o Patients aged between 18 - 60 years old.

  * Both sexes.
  * Physical Status: ASA I and II.

Exclusion Criteria:

* o Refusal of procedure or participation in the study .

  * Physical status: ASA III or above .
  * Infection at site of injection.
  * Psychiatric illness .
  * CNS Diseases like epilepsy, stroke ...etc.
  * History or evidence of coagulopathy .
  * Allergies to drug used (Bupivacaine 0.5%).
  * Patients who suffered from allergy to local anesthetics .
  * Difficult visualization of the anatomy.

Primary outcomes:
measure: The time to first postoperative rescue analgesia.
timeFrame: postoperative 24 hours
Secondary outcomes:
measure: total consumption of opioid in first 24 hours
timeFrame: first 24 hours postoperatively
Other outcomes:
Locations:
city: Cairo
country: Egypt
facility: Ainshams hospitals
Study officials:
affiliation: Ain Shams University
name: sanaa F wasfy
role: PRINCIPAL_INVESTIGATOR
References:
citation: Borys M, Szajowska P, Jednakiewicz M, Wita G, Czarnik T, Mieszkowski M, Tuyakov B, Galkin P, Rahnama-Hezavah M, Czuczwar M, Piwowarczyk P. Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Decreases Persistent Postoperative Pain Severity in Patients Undergoing Both Open and Laparoscopic Nephrectomies-A Randomized Controlled Trial. J Clin Med. 2021 Aug 15;10(16):3590. doi: 10.3390/jcm10163590.