Analgesic Efficacy of Transmuscular Quadratus Lumborum in Patients Undergoing Total Abdominal Hysterectomy

Kuala Lumpur General Hospital

Status: Completed

Conditions: Pain Postoperative

Treatments: Drug: morphine; Procedure: Transmuscular quadratus lumborum block; Drug: ropivacaine

Study type: Interventional

Funder types: Other

Identifiers

NCT02586454

NMRR-15-919-25992

Details and patient eligibility

About

Patients who have undergone laparotomies often require multimodal postoperative pain regimes. In recent years, abdominal wall blocks have been included to become part of this in order to overcome side effects of systemic opioids and complications from epidural analgesia.

Borglum popularised a new approach on abdominal wall blocks by introducing the transmuscular quadratus lumborum (QL) block. Transmuscular QL block is thought to be effective against somatic and visceral pain as local anaesthetic tends to spread from the site of injection to thoracic paravertebral spaces where the sympathetic chain lies.

The objective of this study is to evaluate the analgesic efficacy of transmuscular QL block in patients undergoing total abdominal hysterectomy (TAH) by measuring cumulative opioid consumption, pain score at rest and on movement 24 hours after TAH. Our hypothesis is patients given transmuscular QL block will have lower cumulative opioid consumption.

Enrollment: 64 patients

Sex: Female

Ages: 20 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. ASA I or II
2. Patient's weight > 50kg
3. Elective TAH

Exclusion criteria

1. Body mass index (BMI) > 35 kg/m2
2. Any contraindications to peripheral nerve blocks i.e. local skin infection, coagulopathy, allergy to LA
3. Inability to use patient controlled analgesia
4. Patient on antiplatelet, anticoagulant or on regular use of opioids, paracetamol, nonsteroidal anti-inflammatory drugs or tramadol for chronic condition

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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64 participants in 2 patient groups

Transmuscular quadratus lumborum (QL) block

Experimental group

Description:

Bilateral QL block using 20 ml 0.375% ropivacaine in each side (to a maximum dose 3 mg/kg) plus patient controlled analgesia morphine (1mg/bolus morphine, lockout time 5 minutes) post operative

Treatment:

Drug: ropivacaine

Drug: morphine

Procedure: Transmuscular quadratus lumborum block

Control

Active Comparator group

Description:

Patient controlled analgesia morphine (1mg/bolus morphine, lockout time 5 minutes) post operative

Treatment:

Drug: morphine