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Quadratus Lumborum Block vs Transversus Abdominis Plane Block in Bladder Cancer Surgeries

N

National Cancer Institute, Egypt

Status

Unknown

Conditions

Postoperative Pain
Bladder Cancer
Quadratus Lumborum Block
Surgery
Transversus Abdominis Plane Block

Treatments

Procedure: Transversus abdominis plane block
Procedure: Quadratus lumborum block
Drug: Intravenous opioid

Study type

Interventional

Funder types

Other

Identifiers

NCT04402411
201617049.3

Details and patient eligibility

About

Transversus abdominis plane (TAP) block can be used to provide effective analgesia during the postoperative period following a range of surgeries.

TAP block administers local anesthetics between the T6 to L1 spinal nerve roots to stop the nerve signal and to alleviate pain for abdominal procedures 4, 5.

The viscera are innervated by the vagal nerve (parasympathetic innervation) and by the splanchnic nerves (sympathetic innervation). The splanchnic nerves carry both visceral efferent and afferent nerve fibers. The sensory (or afferent) part of the splanchnic nerves reach the spinal column at certain spinal segments, It is possible to block central visceral pain conduction with thoracic paravertebral blockade or maybe even with the novel quadratus lumborum (QL) block.

The effect of the QL block is believed to result from a spread of LA from its lumbar deposition cranially into the thoracic paravertebral space (TPVS), since Carney et al found traces of contrast agent in the TPVS following application of this block. Hence, the QL block would seem to be able to alleviate both somatic and visceral pain.10

The aim of this study is to compare between quadratus lumborum block, transversus abdominis plane block regarding perioperative analgesia after bladder cancer surgeries by measuring intraoperative hemodynamics, postoperative pain scores and morphine consumption in the first 24 h postoperative.

Full description

Somatic post-surgical pain is very distressing to patients which leads to important complications. Combined multimodal strategies involving nerve blocks, neuroaxial blocks, opiates, and non-steroidal anti-inflammatory drugs are necessary for optimal pain control.

Transversus abdominis plane (TAP) block can be used to provide effective analgesia during the postoperative period following a range of surgeries.

TAP block administers local anesthetics between the T6 to L1 spinal nerve roots to stop the nerve signal and to alleviate pain for abdominal procedures.

A number of systematic reviews have assessed TAP block as a postoperative analgesic compared to one or more specific procedures.

Anterior abdominal wall blocks, as transverse abdominal plexus block, have an important role for only somatic intraoperative and postoperative pain control.

The viscera are innervated by the vagal nerve (parasympathetic innervation) and by the splanchnic nerves (sympathetic innervation). The splanchnic nerves carry both visceral efferent and afferent nerve fibers. The sensory (or afferent) part of the splanchnic nerves reach the spinal column at certain spinal segments, It is possible to block central visceral pain conduction with thoracic paravertebral blockade or maybe even with the novel quadratus lumborum (QL) block.

The effect of the QL block is believed to result from a spread of LA from its lumbar deposition cranially into the thoracic paravertebral space (TPVS), since Carney et al found traces of contrast agent in the TPVS following application of this block. Hence, the QL block would seem to be able to alleviate both somatic and visceral pain.10 Quadratus lumborum block was first described by Blanco in 2007. Blanco described a potential space posterior to the abdominal wall muscles and lateral to the quadratus lumborum muscle. It has been used in abdominoplasties, caesarean sections and lower abdominal operations providing complete pain relief in the distribution area from Th6 to L1 dermatomes. It may be seen as a lumbar approach to the Thoracic Paravertebral Space. The block apparently produces distribution of the local anesthetic extending proximally and over both sides of the surface of the QL muscle, in between the anterior and intermediate layers of the thoracolumbar fascia.

Quadratus lumborum muscle inserts on the lower border of the last rib and by four small tendons into the apices of the transverse processes of the upper four lumbar vertebrae.

Running between its fascia and the muscle are the twelfth thoracic (subcostal), ilioinguinal, and iliohypogastric nerves, The block does not rely on the feeling of any pops or fascial clicks because depending of the angle of the needle several pops can be felt without reaching the target zone, which is lateral to the quadratus lumborum muscle. Actually, the block has never been intended to be conducted without the use of US guidance, and the block is thus a purely USG block.

Aim of study Comparison between quadratus lumborum block, transversus abdominis plane block regarding perioperative analgesia after bladder cancer surgeries by measuring intraoperative hemodynamics, postoperative pain scores and morphine consumption in the first 24 h postoperative.

Enrollment

63 estimated patients

Sex

All

Ages

20 to 80 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • Age of the patients between 20 to 80 years.
  • ASA physical status II -III
  • Elective bladder cancer operations.

Exclusion criteria

  • Patient refusal
  • Local infection at the site of injection
  • Allergy to study medications
  • Sepsis
  • Anatomic abnormalities
  • Systemic anticoagulation or coagulopathy
  • Inability to comprehend or participate in pain scoring system

Trial design

Primary purpose

Other

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

None (Open label)

63 participants in 3 patient groups

Control Group
Active Comparator group
Description:
Patients will receive general anesthesia with intravenous opioid
Treatment:
Drug: Intravenous opioid
Quadratus lumborum
Experimental group
Description:
Patients will receive bilateral quadratus lumborum block
Treatment:
Procedure: Quadratus lumborum block
Transversus abdominis plane
Experimental group
Description:
Patients will receive bilateral transversus abdominis plane block
Treatment:
Procedure: Transversus abdominis plane block

Trial contacts and locations

1

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Central trial contact

Ahmed M Mohammed, MSc

Data sourced from clinicaltrials.gov

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