QL Block Versus EO Plane Block for Analgesia After Open Nephrectomy
Quadratus Lumborum Block Versus External Oblique Plane Block for Analgesia After Open Nephrectomy: A Prospective Randomized Clinical Trial
This prospective randomized clinical trial aims to compare two ultrasound-guided regional anesthesia techniques, the transmuscular quadratus lumborum (QL) block and the external oblique (EO) plane block, for pain relief after open nephrectomy. Open nephrectomy is a major surgical procedure that can cause significant postoperative pain and may require opioid medications for adequate pain control.
Adult patients undergoing open nephrectomy at the National Cancer Institute, Cairo University, who meet the study eligibility criteria will be randomly assigned to receive either a QL block or an EO plane block before surgery. Both techniques will be performed under ultrasound guidance using bupivacaine in addition to standardized general anesthesia and multimodal postoperative analgesia.
The main purpose of the study is to determine whether the QL block provides better postoperative analgesia than the EO plane block. The primary outcome will be the total amount of intravenous morphine consumed during the first 24 hours after surgery. Secondary outcomes will include postoperative pain scores, time to first request for rescue analgesia, hemodynamic changes, recovery time, patient satisfaction, and adverse effects related to analgesia or the regional anesthesia techniques.
A total of 54 patients will be enrolled and randomly allocated equally between the two treatment groups.
Studieoversikt
Status
Forhold
Intervensjon / Behandling
Detaljert beskrivelse
The study is a prospective, randomized clinical trial designed to compare the analgesic efficacy of the transmuscular quadratus lumborum block with the external oblique plane block in adult patients undergoing open nephrectomy.
Open nephrectomy is associated with substantial postoperative pain because of the extent of the surgical incision, muscular dissection, and manipulation of retroperitoneal structures. Effective postoperative analgesia is important to facilitate recovery, mobilization, respiratory function, and patient comfort while minimizing opioid requirements.
The quadratus lumborum block is a posterior abdominal wall fascial plane block in which local anesthetic is deposited in relation to the quadratus lumborum muscle. The technique may provide analgesia over several thoracoabdominal dermatomes and may have both somatic and visceral analgesic effects. The external oblique plane block is a more superficial fascial plane technique that targets the lateral abdominal wall and may provide effective somatic analgesia.
Eligible patients will be randomly allocated in a 1:1 ratio to receive either a transmuscular QL block or an EO plane block before induction of general anesthesia. All patients will receive standardized general anesthesia and multimodal postoperative analgesia. The regional blocks will be performed under ultrasound guidance by an experienced anesthesiologist.
The primary outcome is total intravenous morphine consumption during the first 24 postoperative hours. Secondary outcomes include pain intensity at predefined postoperative time points, both at rest and with movement; time to first request for rescue analgesia; intraoperative and postoperative hemodynamic changes; recovery time; patient satisfaction; and adverse effects, including nausea, vomiting, respiratory depression, and complications related to the regional anesthesia technique.
The study will evaluate whether the QL block provides superior postoperative analgesia and opioid-sparing effects compared with the EO plane block following open nephrectomy.
Studietype
Registrering (Antatt)
Fase
- Ikke aktuelt
Kontakter og plasseringer
Studiekontakt
- Navn: sayed M Abed, MD
- Telefonnummer: 002-01226806532
- E-post: sayed.abed@nci.cu.edu.eg
Studer Kontakt Backup
- Navn: Nourhan R Ali Hassan, Master's
- Telefonnummer: 002-01200858194
- E-post: nourhanrabeaali@gmail.com
Studiesteder
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-
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Cairo, Egypt
- Rekruttering
- Cairo University
-
Ta kontakt med:
- sayed M Abed, MD
- Telefonnummer: 002-01226806532
- E-post: sayed.abed@nci.cu.edu.eg
-
Ta kontakt med:
- Nourhan R Ali Hassan, Master's
- Telefonnummer: 002-01200858194
- E-post: nourhanrabeaali@gmail.com
-
Cairo, Egypt, 11796
- Rekruttering
- Cairo University
-
Ta kontakt med:
- sayed M Abed, MD
- Telefonnummer: 002-01226806532
- E-post: sayed.abed@nci.cu.edu.eg
-
Ta kontakt med:
- Nourhan R Ali Hassan, Master's
- Telefonnummer: 002-01200858194
- E-post: nourhanrabeaali@gmail.com
-
-
Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
- Voksen
- Eldre voksen
Tar imot friske frivillige
Beskrivelse
**Inclusion Criteria:**
- Adult patients aged 18 to 65 years.
- Patients undergoing open nephrectomy at the National Cancer Institute, Cairo University.
- American Society of Anesthesiologists (ASA) physical status II-III.
- Body mass index (BMI) greater than 20 kg/m² and less than 35 kg/m².
**Exclusion Criteria:**
- Patient refusal to participate.
- ASA physical status IV.
- Age less than 18 years or greater than 65 years.
- BMI less than 20 kg/m² or greater than 35 kg/m².
- Known allergy or contraindication to any study medication, including local anesthetics or opioids.
- History of psychiatric disorders or chronic pain.
- Contraindications to regional anesthesia, including local infection at the injection site, pre-existing neuropathy, or coagulopathy.
- Severe organ dysfunction, including cardiac dysfunction (ejection fraction <40%), respiratory dysfunction (FEV1 <50% of predicted or requirement for home oxygen therapy), hepatic dysfunction (Child-Pugh class C), or renal dysfunction (estimated glomerular filtration rate <30 mL/min/1.73 m²).
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Dobbelt
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
|---|---|
|
Eksperimentell: Quadratus Lumborum Block (QL)
Participants will receive an ultrasound-guided transmuscular quadratus lumborum block before induction of general anesthesia.
A total of 30 mL of 0.25% bupivacaine will be administered in the fascial plane between the quadratus lumborum and psoas major muscles.
Participants will also receive the standardized general anesthesia and postoperative multimodal analgesia described in the study protoco
|
Ultrasound-guided transmuscular quadratus lumborum block using 30 mL of 0.25% bupivacaine administered before induction of general anesthesia.
|
|
Eksperimentell: External Oblique Plane Block (EO)
Participants will receive an ultrasound-guided external oblique plane block before induction of general anesthesia.
A total of 30 mL of 0.25% bupivacaine will be administered in the fascial plane between the external oblique and intercostal muscles.
Participants will also receive the standardized general anesthesia and postoperative multimodal analgesia described in the study protocol.
|
Ultrasound-guided external oblique plane block using 30 mL of 0.25% bupivacaine administered before induction of general anesthesia.
|
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
24-hour postoperative morphine consumption
Tidsramme: First 24 hours after surgery
|
Total amount of intravenous morphine administered as rescue analgesia during the first 24 hours after surgery.
Morphine consumption will be recorded for each participant and compared between the quadratus lumborum block and external oblique plane block groups.
|
First 24 hours after surgery
|
Samarbeidspartnere og etterforskere
Sponsor
Etterforskere
- Hovedetterforsker: Mona H Abdelhamid, MD, Professor of anesthesia
Publikasjoner og nyttige lenker
Generelle publikasjoner
- Blanco R, Ansari T, Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: A randomised controlled trial. Eur J Anaesthesiol. 2015 Nov;32(11):812-8. doi: 10.1097/EJA.0000000000000299.
- Elsharkawy H, El-Boghdadly K, Barrington M. Quadratus Lumborum Block: Anatomical Concepts, Mechanisms, and Techniques. Anesthesiology. 2019 Feb;130(2):322-335. doi: 10.1097/ALN.0000000000002524. No abstract available.
- Blanco R. TAP block under ultrasound guidance: the description of a "non-pops technique." Reg Anesth Pain Med. 2007;32(2):130.
Studierekorddatoer
Studer hoveddatoer
Studiestart (Faktiske)
Primær fullføring (Antatt)
Studiet fullført (Antatt)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Faktiske)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- QL block vs EOB in nephrectomy
Plan for individuelle deltakerdata (IPD)
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IPD-planbeskrivelse
Legemiddel- og utstyrsinformasjon, studiedokumenter
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