Nerve Block, Nephrectomy, Analgesia
Conditions
Keywords
quadratus lumborum block, thoracic paravertebral block, nephrectomy
Brief summary
This trial is a prospective, randomized, single-center, open-label, parallel-arm, blinded-analysis trial, the objective of which is to evaluate the effect of transmuscular quadratus lumborum block (TMQLB) in the pain relief and quality of recovery in laparoscopic renal surgery compared with thoracic paravertebral block (TPVB).
Interventions
PROCEDURETMQLB group 1
The patient is placed in the lateral position. The curved (C1-5) probe of Philip CX50 Ultrasound Scanner is used for scan and located vertical to the iliac crest at the posterior axillary line to find the Shamrock sign. The 22-G needle is then inserted in plane and directed to the QL muscle. After the proper position of the needle tip between the psoas major muscle and the quadratus lumborum muscle is confirmed, 0. 4 ml/kg 0.5% ropivacaine with 1: 200,000 adrenaline is injected into the interfascial plane. Followed by IPCA in the first 48h after surgery: morphine boluses: 1.5-2 mg, lockout time :10 min, 1h limitation: 6-8 mg morphine.
PROCEDURETMQLB group 2
The patient is placed in the lateral position. The curved (C1-5) probe of Philip CX50 Ultrasound Scanner is used for scan and located vertical to the iliac crest at the posterior axillary line to find the Shamrock sign. The 22-G needle is then inserted in plane and directed to the QL muscle. After the proper position of the needle tip between the psoas major muscle and the quadratus lumborum muscle is confirmed, 0. 6 ml/kg 0.5% ropivacaine with 1: 200,000 adrenaline is injected into the interfascial plane. Followed by IPCA in the first 48h after surgery: morphine boluses: 1.5-2 mg, lockout time :10 min, 1h limitation: 6-8 mg morphine.
PROCEDURETPVB
The patient is placed in the lateral position, the spinous processes of T10 are identified and marks are made 2cm lateral to the spinous processes. The linear(L12-3) probe of Philips CX50 is placed transversally at the mark to identify the paravertebral space. Then a 22-G needle is inserted in-plane from lateral to medial and advanced until the tip reached the paravertebral space surrounded by the parietal pleura and the superior costotransverse ligament. 0.4 ml/kg 0.5% ropivacaine with 1: 200,000 adrenaline is injected into the paravertebral space of T10. Followed by IPCA in the first 48h after surgery: morphine boluses: 1.5-2 mg, lockout time :10 min, 1h limitation: 6-8 mg morphine.
Sponsors
Cui Xulei
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
17 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* 17\ 80 years of age; * American Society of Anesthesiologists physical status I-III; * undergoing laparoscopic nephrectomy.
Exclusion criteria
* have a known allergy to the anesthetics being used; * infection at injection site * coagulopathy or history of anticoagulants use * chronic analgesics consumption or history of substance abuse * inability to properly describe postoperative pain or recovery to investigators (e.g., language barrier, neuropsychiatric disorder).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| mean VAS of the first postoperative 24 hours | within the first 24 postoperative hours | VAS is an internationally recognized pain scale with 11 points ranging from 0 to 10 points, with 0 defined as no pain and 10 defined as the worst pain imaginable. The VAS will be registered at 0, 2, 4, 8, 12, 24 hours after the surgery, and the primary outcome will be calculated as the mean VAS scores measured at these time point. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| long-term pain control | at 48, 72 and 7 days after the surgery | evaluated by VAS at 48, 72 hours and 7 days after the surgery |
| dermatomal distribution of sensory loss | 10, 20, 30 and 40 minutes after the intervention | evaluated at 10, 20, 30 and 40 minutes after the intervention with pinprick test using Von Frey filaments |
| nausea score | at 0, 2, 4, 8, 12, 24 and 48 hours after the surgery; | — |
| pruritus score | at 0, 2, 4, 8, 12, 24 and 48 hours after the surgery; | — |
| cumulative morphine consumption | at 0, 2,4, 8, 12, 24 ,48, 72hours and 7 day after the surgery | morphine consumption will be registered at 0, 2, 4, 8, 12, 24, 48, 72 hours and 7 days after the surgery and will be calculated as the sum of the values |
| time of recovery of bowel movement | after the surgery | defined as the time to first flatus |
| quality of recovery evaluated by the self-assessment 15-item quality of recovery (QoR) scale | at 3 days and 5 days after the sugery | QoR is a 15-item questionnaire which will score on a scale of 0-10 pertaining to patient's comfort, support system, pain, well-being, and ability to carry out daily activities, where 0 indicates none of the time and 10 indicates all of the time |
| postoperative length of hospital stay | after the surgery | time to patient's discharge |
| patient satisfaction with anesthesia | at 48 hours after the surgery | evaluated with the Chinese version of Bauer questionnaire at 48 hours after the surgery |
| ambulation time | after the surgery | time to patient's first walking after the surgery |
Countries
China
Outcome results
None listed