Ultrasound Guided Quadratus Lumborum Block for Postoperative Pain in Abdominoplasty

St Joseph University, Beirut, Lebanon

Status: Completed

Conditions: Pain

Treatments: Procedure: QLB bloc; Drug: 0.9% normal saline; Drug: 0.2% Ropivacaine

Study type: Interventional

Funder types: Other

Identifiers

NCT02932930

USJ-02

Details and patient eligibility

About

The original concept of a quadratus lumborum block (QLB) indicated for analgesia after abdominal surgery was first described by Blanco in 2007. Also referred to as a posterior transversus abdominis plane (TAP) block, the QLB consists in deposition of local anesthetic on either the posterior or the anterolateral border of the quadratus lumborum muscle. TAP blocks have already been proved effective in urologic, abdominal, and gynecologic procedures by blocking the sensory nerve supply to the anterior abdominal wall thus reducing the amount of postoperative analgesic medication. The main advantages of QLB compared to the TAP block is a wider sensory block area and a longer duration of analgesia. This is due to the extension of local anesthetic agents beyond the TAP plane to the thoracic paravertebral space(4).

Previous reports have shown that QLB is effective in providing pain relief after various abdominal operations. However, there are no published reports on QLB for postoperative pain after abdominoplasty. This prospective, randomized, double-blinded, controlled study aims to evaluate the analgesic efficacy, opioids consumption and quality of recovery of QLB in patients undergoing abdominoplasty. Patients scheduled to have abdominoplasty will be randomized to receive bilateral QLB with either ropivacaine 0.2% or normal saline. Post-operative cumulative analgesic medication consumption, pain severity at rest and on movement, as well as quality of recovery will be evaluated and compared in both groups.

Enrollment: 40 patients

Sex: Female

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Standard abdominoplasty procedure
2. Written informed consent
3. Age ≥ 18 years
4. Female

Exclusion criteria

1. Patient's refusal
2. Allergies to any study medication
3. Inability to comprehend or participate in scoring scales
4. Deformations that could possibly affect the spread of the local anesthetic in the quadratus lumborum muscle plane
5. Quadratus lumborum muscle plane not seen in ultrasound examination
6. Coagulopathy or on anticoagulants

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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40 participants in 2 patient groups, including a placebo group

QLB group

Active Comparator group

Description:

Patients will receive at the beginning of the surgery 0.2 ml/kg of 0.2% ropivacaine bilaterally. Procedure: Quadratus Lumborum Block type II, local anesthetic injection on the posterior border of the quadratus lumborum muscle Drug: Ropivacaine, 0.2 ml/kg of 0.2% ropivacaine

Treatment:

Drug: 0.2% Ropivacaine

Procedure: QLB bloc

Control group

Placebo Comparator group

Description:

Patients will receive at the beginning of the surgery 0.2 ml/kg of 0.9% normal saline bilaterally. Procedure: Quadratus Lumborum Block type II, local anesthetic injection on the posterior border of the quadratus lumborum muscle Drug: Normal saline, 0.2 ml/kg of 0.9 % normal saline

Treatment:

Drug: 0.9% normal saline

Procedure: QLB bloc