Preoperative Versus Postoperative Quadratous Lunborum Block in Nephrectomy

Preoperative Versus Postoperative Ultrasound Guided Quadratous Lunborum Block for Postoperative Analgesia Following Open Nephrectomy, Acomparative Study

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

Study Overview

• Status: Completed
• Conditions: Regional Blocks; Renal Surgery
• Intervention / Treatment: Other: quadratous lumborum block

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.

• Study Type: Interventional
• Enrollment (Actual): 100
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Cairo Governorate
    • Cairo, Cairo Governorate, Egypt, 11591
      • Ainshams hospitals

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

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.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: preoperative quadratous lumborum block; patients weill recieve preoperative ultrasound guided quadratous lumborum block at lateral position before start of surgery after induction of general anesthesia	Other: quadratous lumborum block; The patient will be placed in the lateral position, after sterilization.. QLB will be done using ultrasound, The probe will be positioned superior to the iliac crest, in the transverse orientation, at the posterior axillary line. The Shamrock sign will be identified at the L4 level, and the insulated nerve block needle will be advanced from posterior to anterior, through the QL muscle, until the needle tip is visualized in the interfascial plane between the QL muscle and psoas muscle. As the correct needle placement is confirmed with 2-3 mL of saline, 20 mL of 0.25% bupivacaine will be injected ensuring that the psoas muscle will be pushed deeply.; Other Names: myofascial block
Active Comparator: postoperative quadratous lumborum block; patients weill recieve postoperative ultrasound guided quadratous lumborum block at lateral position at the end of surgery before recovery from general anesthesua	Other: quadratous lumborum block; The patient will be placed in the lateral position, after sterilization.. QLB will be done using ultrasound, The probe will be positioned superior to the iliac crest, in the transverse orientation, at the posterior axillary line. The Shamrock sign will be identified at the L4 level, and the insulated nerve block needle will be advanced from posterior to anterior, through the QL muscle, until the needle tip is visualized in the interfascial plane between the QL muscle and psoas muscle. As the correct needle placement is confirmed with 2-3 mL of saline, 20 mL of 0.25% bupivacaine will be injected ensuring that the psoas muscle will be pushed deeply.; Other Names: myofascial block

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The time to first postoperative rescue analgesia.	the first time patient ask for analgesia	postoperative 24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
total consumption of opioid in first 24 hours	amount of narcotic needed by patient in first 24 hours after nephrectomy	first 24 hours postoperatively

Collaborators and Investigators

• Sponsor: Ain Shams University
• Investigators: Principal Investigator: sanaa F wasfy, Ain Shams University

Publications and helpful links

General Publications

• 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.

Study record dates

Study Major Dates

• Study Start (Actual): July 29, 2023
• Primary Completion (Actual): May 28, 2025
• Study Completion (Actual): September 27, 2025

Study Registration Dates

• First Submitted: May 6, 2023
• First Submitted That Met QC Criteria: May 6, 2023
• First Posted (Actual): May 16, 2023

Study Record Updates

• Last Update Posted (Actual): May 19, 2026
• Last Update Submitted That Met QC Criteria: May 18, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: multimodal analgesia, regional blocks, renal surgeries
• Other Study ID Numbers: MS 183/2023

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No