Bilateral Ultrasound Guided Intramuscular Quadratus Lumborum Plane Block Versus Bilateral Lateral Quadratus Lumborum Plane Block in Controlling Postoperative Pain in Cancer Patients Undergoing Open Nephrectomy

National Cancer Institute, Egypt

Status: Enrolling

Conditions: Postoperative Pain; Cancer Patients; Intramuscular Quadratus Lumborum Plane Block; Bilateral; Lateral Quadratus Lumborum Plane Block; Open Nephrectomy; Ultrasound

Treatments: Drug: Lateral quadratus lumborum block; Drug: General anesthesia; Drug: Intramuscular quadratus lumborum block

Study type: Interventional

Funder types: Other

Identifiers

NCT06889987

AP2412-201-088-194

Details and patient eligibility

About

This study aims to evaluate the efficacy of bilateral ultrasound-guided intramuscular quadratus lumborum plane block (QL4) versus bilateral lateral quadratus lumborum plane block (QL1) in controlling postoperative pain in cancer patients undergoing open nephrectomy.

Full description

Post-surgical somatic pain is very distressing to patients, which may lead to significant complications.

Practitioners initially used these as ilioinguinal, iliohypogastric, rectus sheath blocks, and in the early 21st century, transversus abdominis plane (TAP) blocks. A recent variation of the TAP block is known as the quadratus lumborum block (QLB).

The QL block effectiveness is believed to result from the spread of Local Anesthetic cranially from the lumbar deposition into the thoracic paravertebral space (TPVS). So, the QLB seems to relieve somatic and visceral pains.

Enrollment: 90 estimated patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age from 18 to 65 years.
• Both sexes.
• American Society of Anesthesiology (ASA) physical status II-III.
• Body mass index (BMI): (20- 40) kg/m2.
• Type of surgery: midline incision for unilateral open nephrectomy.

Exclusion criteria

• Patient refusal.
• Age <18 years or >65 years
• BMI <20 kg/m2 and > 40 kg/m2
• Known sensitivity or contraindication to drugs used in the study
• Contraindication to regional anesthesia, e.g. local infection at the introduction site, pre-existing peripheral neuropathies and coagulopathy.
• Physical status ASA IV
• Patients on chronic analgesic therapy (daily morphine ≥30 mg or equivalent dose of other opioids or tramadol or any medication for neuropathic pain)
• Patients with a history of drug abuse
• Patients with neuropsychiatric diseases; patients with a history of chronic pain syndromes that may enhance sensitivity to pain, for example, fibromyalgia
• All patients who are going to have severe intra- or post-operative bleeding or will require postoperative mechanical ventilation are also excluded from the study.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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90 participants in 3 patient groups

Intramuscular quadratus lumborum group

Experimental group

Description:

Patients will receive bilateral ultrasound-guided intramuscular quadratus lumborum block with an injection of 0.4 ml/kg bupivacaine 0.25% after induction of general anesthesia.

Treatment:

Drug: Intramuscular quadratus lumborum block

Lateral quadratus lumborum group

Experimental group

Description:

Patients will receive bilateral Ultrasound-guided lateral quadratus lumborum with injection of 0.4 ml/kg of bupivacaine 0.25 after induction of general anesthesia.

Treatment:

Drug: Lateral quadratus lumborum block

Control group

Active Comparator group

Description:

Patients will receive only general anesthesia without any block

Treatment:

Drug: General anesthesia