Renal Transplant Donor of Left Kidney
Conditions
Keywords
stress response, kidney donor, Cellular Imunological Function, quadratus lumborum block, numerical rating scale, morphine patient controlled analgesia
Brief summary
This study aimed to compare Quadratus Lumborum Block to Epidural on Stress Response and Perioperative Cellular Immunological Function of Laparoscopic Nephrectomy Kidney Donor
Detailed description
Sixty-two subjects were given informed consent before enrolling the study and randomized into two groups; quadratus lumborum block and epidural. Non-invasive blood pressure monitor, electrocardiogram (ECG), and pulse-oxymetry were set on the subjects in the operation room. General anesthesia induction was done by fentanyl 2 mcg/kg and propofol 1-2 mg/kg. Endotracheal tube (ETT) intubation was facilitated with Atracurium 0.5mg/kg as muscle relaxant. Maintenance was done by sevoflurane, oxygen, and compressed air. On quadratus lumborum block group, bilateral block using ultrasound will be performed with stimuplex 100mm needle with 20 cc of bupivacaine 0.25% as regimen. On epidural group, epidural catheter was inserted under general anaesthesia on left lateral decubitus position (5 cm depth inside the epidural space) at level Th10-Th11. The catheter insertion was confirmed with vacuum aspiration and negative test-dose. Before first incision, patient will be given continuous epidural Bupivacaine 0.25% 6 mL/hour. Blood sample was drawn for interleukin-6, blood glucose, and c-reactive protein as baseline data. After surgery, patient were extubated until fully conscious and can follow command verbally. Patient will be transported in recovery room post operation.
Interventions
PROCEDUREQuadratus Lumborum Block
Bilateral block using ultrasound will be performed before surgery and after surgery on patient using Stimuplex 100mm needle with Bupivacaine 0.25% 0.4 mL/kg, maximum dose 25 mL each side under general anaesthesia
PROCEDUREContinuous Epidural
Patient will be given 6 mL/hour of Bupivacaine 0.25% for intraoperative analgesia and continued epidural 6 mL/hour Bupivacaine 0,125% as postoperative analgesia in 24 hours.
Sponsors
Indonesia University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
Yes
Inclusion criteria
* Kidney donor patients undergoing laparoscopic nephrectomy * Body mass index below 30 * Duration of surgery 4 to 6 hours * Patients who agreed to participate in this study and sign informed consent.
Exclusion criteria
Have contraindication for quadratus lumborum block * Have contraindication for epidural * Previous history of local anesthetic drug allergy * inability to communicate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from Baseline Interleukin-6 at 24 hours after abdominal insufflation | Before procedure, at the end of surgery, and 24 hours after abdominal insufflation | Measure by ELISA |
| Cumulative morphine requirement at 2 hours, 6 hours, 12 hours, 24 hours postoperative | 2 hours, 6 hours, 12 hours, 24 hours. | Cumulative morphine consumption at each time point in 24 hours after surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change from Baseline Blood Glucose at 2 hours after abdominal insufflation | Before procedure and 2 hours after abdominal insufflation | Measured by finger-stick blood sample |
| Change from Baseline Blood pressure | Intraoperative and 24 hours | Measured by non-invasive blood pressure monitoring at before anaesthesia induction (baseline), post-induction, gas-insufflation, Pfannenstiel incision, end of surgery, and 24 hours surgery |
| Change from Baseline Mean Arterial Pressure | Intraoperative and 24 hours | Measured by non-invasive blood pressure monitoring at before anaesthesia induction (baseline), post-induction, gas-insufflation, Pfannenstiel incision, end of surgery, and 24 hours surgery |
| Change from Baseline Cardiac Index | Intraoperative and 24 hours | Measured by cardiometry ICON® at before anaesthesia induction (baseline), post-induction, gas-insufflation, Pfannenstiel incision, end of surgery, and 24 hours surgery |
| Change from Baseline Heart Rate | Intraoperative and 24 hours | Measured by pulse oximetry at before anaesthesia induction (baseline), post-induction, gas-insufflation, Pfannenstiel incision, end of surgery, and 24 hours surgery |
| Change from Baseline hs-CRP at 48 hours after abdominal insufflation | Before procedure, at the end of surgery, and 48 hours after abdominal insufflation | Measured with ELISA |
| Change from Baseline Patient Controlled Analgesia at 2, 6, 12 and 24 hours after procedure | 2, 6, 12, and 24 hours after procedure | Measure by how many times patient use morphine PCA analgesia |
| Total bupivacaine used in 24 hours | 24 hours | Total bupivacaine used until 24 hours postoperatively |
| Change from baseline motor block at 2, 6, 12, and 24 hours after anesthesia recovery | 2, 6, 12, and 24 hours after procedure | Measured by Bromage score |
| Number of participants with paresthesia after procedure | 24 hours | in percentage |
| Duration of urinary catheter | 24 hours | in hours |
| Level of sensory block after procedure | 24 hours | Measured by cold and pin prick sensation |
| Time to first morphine requirement | 24 hours | Duration from end of anesthesia until first attempt of morphine requirement in minutes |
| Change from Baseline Pain Intensity at 2, 6, 12, and 24 hours after procedure | 2, 6, 12, and 24 hours after procedure | Measured by Numerical Rating Scale |
Countries
Indonesia
Outcome results
None listed