Volume vs Concentration: Quadratus Lumborum Blocks With High Volume/Low Concentration or Low Volume/ High Concentration in Nephrectomies

Bruce Ben-David

Status and phase: Withdrawn; Phase 4

Conditions: Block; Postoperative Pain; Analgesia

Treatments: Drug: Ropivacaine 0.5% Injectable Solution

Study type: Interventional

Funder types: Other

Identifiers

NCT04077398

STUDY19070444

Details and patient eligibility

About

The quadratus lumborum has since 2016 become standard of care for abdominal and retroperitoneal surgeries at UPMC-Shadyside Hospital, replacing paravertebral blocks, and as part of a broader multimodal analgesia institutional Enhanced Recovery After surgery protocol. Since the first description of this technique, several approaches to and anatomic targets within the quadratus lumborum plane have been described although their mechanism of action, spread, and relative clinical effectiveness remain areas of some debate. What is proposed here is to investigate the relative clinical effectiveness of the relationship high volume/low concentration of local anesthetic or low volume/ high concentration of local anesthetic.

Sex: All

Ages: 18 to 90 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Patients 18-90 years old
2. Patients undergoing nephrectomy
3. Body Mass Index 19-36
4. Male and Female
5. All races
6. American Society of Anesthesiologist scale I, II, III

Exclusion criteria

1. Patient refusal
2. Pregnancy
3. Non-English speaking or inability to participate in the study
4. Patients with coagulopathy or With International Normalized Ratio >1,5 the day of the surgery.
5. Chronic steroid use
6. Chronic pain
7. Chronic opiate use

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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0 participants in 2 patient groups

low volume High concentration group

Experimental group

Description:

1.Low Volume: 30 subjects randomized to Low Volume will receive bilateral Quadratus lumborum Block II. Each block of 0,75% ropivacaine x 15 mL + dexmedetomidine 0.4 mcg/kg (max dose 30 mcg for age \<70, max dose 20 mcg for age \>70) + dexamethasone 4 mg

Treatment:

Drug: Ropivacaine 0.5% Injectable Solution

high volume low concentration

Experimental group

Description:

2.High Volume: 30 subjects randomized to High Volume will receive bilateral Quadratus lumborum Block II. Each block of 0,375% ropivacaine x 30 mL + dexmedetomidine 0.4 mcg/kg (max dose 30 mcg for age \<70, max dose 20 mcg for age \>70) + dexamethasone 4 mg

Treatment:

Drug: Ropivacaine 0.5% Injectable Solution