Nephrostomy; Complications, Upper Urinary Tract Dilatation and Obstruction, Regional Anesthesia Morbidity, Adverse Anesthesia Outcome
Conditions
Keywords
Percutaneous Nephrostomy, Quadtatus Lumborum Block, Cancer, Monitored Anaesthesia Care
Brief summary
Percutaneous nephrostomy (PCN) is one of the interventions in the radiology department in which pain control is necessary. Quadratus Lumborum (QL) block will be tried to limit the use of systemic analgesics and its accompanying untoward effects in those frail patients requiring PCN that is performed in the prone position.
Detailed description
Quadratus Lumborum block is a novel technique in which extension into the thoracic paravertebral space may occur. QL block would seem to be able to alleviate both somatic and visceral pain so it's expected to decrease the need for systemic sedation\\analgesia to a minimum.
Interventions
PROCEDURELocal Anesthetic infiltration
Lignocaine infiltration through the nephrostomy track
PROCEDUREQuadratus Lumborum block
A linear 12-MHz ultrasound probe will be placed in the anterior axillary line to visualize the typical triple abdominal layers. Then, the probe will be placed in the midaxillary line and at this point the layers of abdominal layers starte to taper. The probe will be placed in the posterior axillary line, sonoanatomy will show first the transversus abdominis disappearing then the internal oblique and external oblique forming aponeurosis and appearance of QL will be noticed. At the posterior border of the quadratus lumborum muscle and outside the fascia, Touhe needle will be inserted in plane and confirmed its position by injecting saline. Under ultrasound (US) guidance, local anesthetic mixure will be deposited separating the fascia
DRUGMAC
Incremental doses are given to the targed sedation and analgesia
Sponsors
National Cancer Institute, Egypt
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. ASA grade III and IV patients, 2. Ureteral obstruction due to malignancy or secondary to urinary diversion after cystectomy
Exclusion criteria
1. Bleeding diathesis; INR more than than 1.5 and platelet count less than 100,000/mm3. 2. Untreated urinary tract infection; 3. Pre-operative haemoglobin \<10 gm/dl, 4. Severely co morbid patients 5. Non-dilated renal collecting system 6. Patient refusal to consent for the procedure.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Analgesia | 4 hours | Verbal Rating Scale is assessed for degree of pain during the procedure and after till discharge from the radiology department. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Respiratory Depression | 4 hours | Respiratory rate and airway patency is monitored with an anesthesiologist. |
| Sedation | 4 hours | Ramsay Seadation Score is assessed during and after procedure till discharge |
| Cardiovascular stability | 4 hours | Blood pressure and Heart rate is assessed during and after procedure till discharge |
| Patient Satisfaction | 48 hours | Patient Satisfaction Quistionaire |
Countries
Egypt
Outcome results
None listed