Postoperative Pain
Conditions
Keywords
quadratus lumborum block, continuous epidural, postoperative analgesia, kidney transplant
Brief summary
Quadratus lumborum block as an alternative for postoperative analgesia compared with epidural block
Detailed description
Epidural analgesia is the main choice of analgesia following kidney transplant surgery. However, continuous epidural technique had some concerning side effects such as hemodynamic instabilities, urine retention, motor/sensory disturbances/weakness, and mobilisation comfort, it could also cause hypotension which could affect graft success. Quadratus lumborum (QL) block had lesser side effects thus could be an option for postoperative analgesia, however there are no study showing the safety and success rate of QL block techniques for patients who underwent kidney transplant surgery.
Interventions
PROCEDUREContinuous Epidural analgesia
Continuous Epidural catheter is inserted at the Thoracic 11-T12 level, using Ropivacaine 0.375% 3 mL bolus followed by Ropivacaine 0.2% with rate 6 mL/hour for 24 hours after laparoscopic nephrectomy
PROCEDUREBilateral Quadratus Lumborum block
Bilateral anterior Quadratus Lumborum block using Ropivacaine 0.375% 20 mL each injection as postoperative analgesia treatment for 24 hours
Sponsors
Indonesia University
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
Yes
Inclusion criteria
* Patients undergoing elective kidney transplant laparotomy surgery * Agrees to participate in research * BMI \< 30 kg/m2
Exclusion criteria
* Declines to participate in research * Contraindications to intervention procedures (epidural or quadratus lumborum block) * History of local anaesthetic allergy * Systemic allergic reactions, anaphylactic reaction, cardiac arrest * Failure of intervention procedures (epidural or quadratus lumborum block) * Intraoperative complications (massive bleeding, hypotension)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Morphine consumption | 24 hours | Additional analgesia required at 2, 6, 12, and 24 hours after surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| First time morphine required | 24 hours | Total time gap from postoperative analgesia procedure administration to first morphine requirement |
| Total minimum and maximum dose of vasoactive agents | 24 hours | Minimum and maximum dose of norepinephrine and dobutamine as vasoactive agents within 24 hours after surgery |
| Urine output | 24 hours | Urine output (mL/kgBW/hour) after surgery |
| Pain Intensity | 24 hours | Pain intensity measured using the Visual Analogue Scale (VAS) at 2, 6, 12, and 24 hours after surgery. VAS assessed with horizontal line 0-100 mm for no pain to the worst pain, with range 0-30 mm for none to mild pain, 31-70 mm for moderate pain, 71-100 mm for severe pain. |
| Ramsay score | 24 hours | Ramsay score at 2, 6, 12, and 24 hours after surgery to assess patient sedation level. |
| Dermatomal coverage of analgesia procedure | Immediately after anaesthesia completion | dermatome sensory block distribution using cold sensation test |
| Blood ropivacaine level | 24 hours | Arterial blood sample of all subjects will be withdrawn approximately 3 mL from the arterial line at 0, 30, 45, 60 minute, and 2, 4, 6,12,18, 24 hours after designated analgesia procedure, and will be used for ropivacaine blood level measurements using High-Performance Liquid Chromatography (HPLC), to measure Total plasma ropivacaine concentration (Cstop), maximum plasma concentration (Cmax), time of maximum plasma concentration, area under the curve (AUC) |
| Bromage score | 24 hours | Bromage score at 2, 6, 12, and 24 hours after surgery to assess lower limb motoric block. Score for Bromage: 1. free movement 2. partial block 3. almost complete 4. complete block |
Countries
Indonesia
Outcome results
None listed