Efficacy and Safety of Adding Dexmedetomidine to Levobupivacaine in Rectus Sheath Block Compared to Quadratus Lumborum Block in Patients Undergoing Lower Abdominal Cancer Surgery: a Randomized Clinical Trial

November 17, 2024 updated by: Kerollos Ibrahim Gayed Ibrahim, Assiut University
Surgical trauma activates numerous receptors leading to severe postoperative pain. Seventy to seventy-five percent of the pain is somatic, originating from the anterior abdominal wall, and it often persists for 72 hours after open surgery. The objective of this study is to compare the efficacy and safety of adding dexmedetomidine to Levobupivacaine in rectus sheath block with quadrates lumborum block in patients undergoing lower abdominal cancer surgeries.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Postoperative pain may cause tachycardia, hypertension, increased cardiac work, nausea, vomiting and ileus. Also, if it is inadequately managed it may lead to hazardous cardiovascular effects, pulmonary dysfunction, immune system, neuro-endocrine and metabolic effects, gastrointestinal- urinary- and cognitive dysfunction and also have psychological, economic and social adverse effects. Therefore, effective pain management is a priority of care and a patient's right.

The American Society of Anesthesiologists recommends use of multimodal pain regimens to minimize opioid use and improve pain control . Opioids are still the go-to medication for treating visceral pain, but they are ineffective against somatic discomfort. An effective Multimodal pain management protocol uses combinations of opioid prescriptions, nonopioid prescription, regional and local anesthesia, and nonpharmacological therapy . To mitigate the adverse consequences of opioid overconsumption, peripheral and regional anesthetic blocks were implemented. The Quadratus lumborum block is one of the perioperative pain management procedures that is administered to patients of all ages who are undergoing abdominal surgery . Nevertheless, there is persistent disagreement regarding the optimal method of administering the block due to the ambiguous mechanisms that are responsible for its effects.

We sought an alternative, such as the Rectus sheath block, to prevent postoperative somatic pain, due to the potential complications of the QLB technique, including retroperitoneal hemorrhage, abscess, and pleural injury . The block was not frequently applied, or insufficient blocks could not be achieved primarily with a single injection method prior to taking advantage of ultrasonography. This was due to the proximity of medicated zones and vital organs, as well as the coherent and thin muscle layers. Currently, this approach is being implemented with catheter placement in the rectus sheath, ultrasonography guidance, and a single injection .

At present, several adjuvants have been added to local anesthetics used in peripheral and regional blocks to decrease the dosage of local anesthetic and enhance its effectiveness . Dexmedetomidine is an adjuvant that acts as a selective alpha two adrenoreceptor stimulating agent. This medication induces drowsiness, analgesia, sympatholysis, and anxiolysis in a dose-dependent manner, without causing significant respiratory depression.

Study Type

Interventional

Enrollment (Estimated)

122

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. Patients subjected to major lower abdominal cancer surgeries.
  2. The enrolled age will be from 18 years to 70 years
  3. ASA I-III and NYHA I-III.

Exclusion Criteria:

  1. ASA physical status >III and NYHA>III
  2. Patient refusal
  3. Body mass index >40 kg/m2
  4. Preoperative opioid consumption
  5. Infection at the incision site
  6. A history of hematological disorders or coagulation abnormality
  7. Previous abdominal surgeries, severe hepatic or renal impairment
  8. Pregnant women

10- Hypersensitivity to any of used drugs

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Quadratus lumborum block (QLB group)
patients will receive bilateral QLB with a 40-ml mixture of 20 ml of 0.5% levobupivacaine diluted with 20 ml of 0.9% N.S. (20 ml to be injected on each side).
Drug: Levobupivacaine
40-ml mixture of 20 ml of 0.5% levobupivacaine diluted with 20 ml of 0.9% N.S. (20 ml to be injected on each side
Experimental: Rectus sheath block (RSB group)
patients will receive bilateral RSB with a 60 ml mixture of 1.5 mic/kg dexmedetomidine added to 30 ml of 0.5% levobupivacaine diluted with 30 ml of 0.9% N.S. (30 ml to be administered on each side, divided into 15 ml for the upper segment and 15 ml for the lower segment).
Drug: Levobupivacaine + Dexmedetomidine
60 ml mixture of 1.5 mic/kg dexmedetomidine added to 30 ml of 0.5% levobupivacaine diluted with 30 ml of 0.9% N.S. (30 ml to be administered on each side, divided into 15 ml for the upper segment and 15 ml for the lower segment).

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
pain intensity
Time Frame: 24 hours
measured by VAS immediately postoperatively, then at 2-, 4-, 6-, 8-, 12-, 18-, 24-hours after surgery.
24 hours

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Assiut University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

December 1, 2024

Primary Completion (Estimated)

December 1, 2026

Study Completion (Estimated)

January 1, 2027

Study Registration Dates

First Submitted

November 17, 2024

First Submitted That Met QC Criteria

November 17, 2024

First Posted (Estimated)

November 19, 2024

Study Record Updates

Last Update Posted (Estimated)

November 19, 2024

Last Update Submitted That Met QC Criteria

November 17, 2024

Last Verified

November 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • dexmedetomidine QLB

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

Yes

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Abdominal Cancer Surgery

Clinical Trials on Levobupivacaine

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Uzbekistan

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Subscribe