Postoperative Pain
Conditions
Keywords
quadratus lumborum block, pre-emptive analgesia, laparoscopic nephrectomy
Brief summary
Quadratus lumborum (QL) block can reduce intraoperative opioid consumption, decrease inflammation responses of IL-6, and reduce acute pain intensity in comparison with non-receiving QL block as the control group.
Detailed description
Quadratus lumborum block had been studied as an effective postoperative analgesia in lower abdominal surgery, due to its spread to the thoracic paravertebral space and thoracolumbar fascia nerve. The effect of preincisional ultrasound (US)-guided QL block as preemptive analgesia on patient underwent laparoscopic living donor nephrectomy has never been evaluated. As preemptive analgesia, quadratus lumborum block could provide analgesics before and after surgery. Both groups immediately received basic postoperative analgesia regimen paracetamol 1 gr IV 8th hourly.
Interventions
DRUGNon-QL block
Only received fentanyl IV during surgery.
Bilateral lateral Quadratus Lumborum block using 20 ml of 0.25% bupivacaine each injection as preemptive analgesia.
Sponsors
Indonesia University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Investigator)
Masking description
Forty-four healthy patients with American Society of Anesthesiologists (ASA) classification I or II gave written consent to participate and were randomly allocated into QL block group or control (non-QL block) group. Randomisation used blocks of 4 into 2 groups using a list of random numbers and was performed by sealed envelopes. The surgeries were performed by 3 urology surgeon consultants with comparable distributions. Patients and principal investigator were blinded to group allocation.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* BMI \< 30 kg/m2 * ASA 1 or 2
Exclusion criteria
* refused to participate * chronic use of analgesics or anti-inflammatory drugs * allergy to local anaesthetic * duration of surgery \<4 or \> 6 hours * duration of anaesthesia \<5 or \> 7 hours * neuropathy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intraoperative fentanyl consumption | Intraoperative | Intraoperative fentanyl consumption was recorded as total consumption in µg, and calculated into mean consumption per hour in µg.kg-1.h-1, due to the influence of patients body weight and duration of surgery to the given dose of fentanyl boluses. |
| Changes in Interleukin-6 from baseline | 24 hours | Measurement of plasma Interleukin-6 before the anaesthesia induction as the baseline; 2 hours of surgical stimulation and gas insufflation intraoperatively; and 2 hours after recovery from anaesthesia. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hemodynamic Profiles: Systolic, Diastolic, and Mean Arterial Pressure in mmHg | Intraoperative | The trends of perioperative haemodynamic profiles during and after surgery : systolic, diastolic and mean arterial pressure in mmHg |
| Numerical Rating Scale | 24 hours | Pain measurement using Numerical Rating Scale (NRS) at rest and during movement. NRS from 0 =no pain to 10= worst pain at 2 hours and 24 hours after anaesthesia recovery |
| Number of participants with additional intravenous fentanyl | 24 hours | If the pain relief was still inadequate after increasing tramadol boluses, the extra fentanyl 1 µg.kg\^-1 IV boluses was given at every 15-30th minute until the NRS ≤ 3. |
| Number of participants with additional intravenous tramadol | 24 hours | During observation after surgery, when the NRS began to increase \> 3 at rest the intermittent tramadol 50 mg IV boluses was given 8th hourly. If the NRS still remained \> 3, the intermittent tramadol 50 mg IV boluses were administered more frequently up to 4th hourly. |
| Hemodynamic Profiles: Heart Rate in bpm | Intraoperative | The trends of perioperative haemodynamic profiles during and after surgery: heart rate in beat per minute |
Countries
Indonesia
Outcome results
None listed