ESPB vs PVB vs QLB After Pelvi-ureteric Surgeries

Kafrelsheikh University

Status: Completed

Conditions: Erector Spinae Plane Block; Quadratus Lumborum Block; Analgesia; Paravertebral Block

Treatments: Procedure: TPVB Technique; Procedure: ESPB Technique; Procedure: QLB Technique

Study type: Interventional

Funder types: Other

Identifiers

NCT05713643

MKSU 50-12-12

Details and patient eligibility

About

The aim of this study is to compare the analgesic efficacy of erector spinae plane block versus thoracic paravertebral block versus quadratus lumborum block on postoperative analgesia after pelvi-ureteric surgeries.

Full description

Opioid-based analgesia plays a significant role in the control of postsurgical pain; however, use of opioid may lead to significant side effects (e.g., nausea and vomiting) and adverse events (e.g. respiratory depression), which may be associated with significantly longer hospital stays and higher hospital costs in the postsurgical setting .

Thoracic paravertebral block (TPVB) is a classic trunk block with definite analgesic effect for both somatic and visceral pain.

Quadratus Lumborum block (QLB) is a widely used regional anesthesia technique as well. It has been used for reducing postoperative pain after cesarean section, laparotomy or laparoscopic procedure and hip surgery.

Erector spinae plane block (ESPB) is a novel inter-fascial plane block first introduced by Forero et al. in 2016 , providing wide-ranging analgesia in lung surgery, laparoscopy, mastectomy, and pediatric surgery. The proposed mechanism of ESPB is that distribution of local anesthetic solution spreads into the para-vertebral space and epidural space, which then blocks the dorsal, ventral, and traffic branches of spinal nerve.

ESPB, TPVB and QLB III have been shown to improve analgesic outcome after urological surgeries.

Enrollment: 90 patients

Sex: All

Ages: 21 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 18-65 years
• Both genders
• American Society of Anesthesiologists (ASA) physical status I-III
• Undergoing elective pelvi-ureteric surgeries.

Exclusion criteria

• Body Mass Index > 30 kg/m2.
• Contraindication of deep nerve block such as allergic to anesthetic drug, coagulation disorder, and infection at the injection site.
• Chronic opioids dependence or chronic pain over 3 months.
• Use of medication such as gabapentin-pregabalin could affect pain perception.
• Unable to communicate preoperatively due to severe dementia, language barrier, or neuropsychiatric disorder.
• Unable to perform nerve block procedure due to difficult anatomy through ultrasound scan.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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90 participants in 3 patient groups

ESPB group

Active Comparator group

Treatment:

Procedure: ESPB Technique

TPVB group

Active Comparator group

Treatment:

Procedure: TPVB Technique

QLB group

Active Comparator group

Treatment:

Procedure: QLB Technique