Analgesia, Block, Postoperative Pain
Conditions
Brief summary
The quadratus lumborum has since 2016 become standard of care for abdominal and retroperitoneal surgeries at UPMC-Shadyside Hospital, replacing paravertebral blocks, and as part of a broader multimodal analgesia institutional Enhanced Recovery After surgery protocol. Since the first description of this technique, several approaches to and anatomic targets within the quadratus lumborum plane have been described although their mechanism of action, spread, and relative clinical effectiveness remain areas of some debate. What is proposed here is to investigate the relative clinical effectiveness of the relationship high volume/low concentration of local anesthetic or low volume/ high concentration of local anesthetic.
Interventions
DRUGRopivacaine 0.5% Injectable Solution
There will be two groups, in order to compare two different sets of volumes with the same amount of drug. we will try to identify if it is better one volume over the other in terms of pain control and consume of opioids, as well the presence or absence of motor weakness.
Sponsors
Bruce Ben-David
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
Randomization will be performed with software excel or spss. This randomization will be kept in an envelope. After the patient consents participation in the study, the investigator and the care provider will open the envelope and will perform the block according to the established in the randomization. The patient or the outcomes assessor will not have access to the volume and concentration used during the block. Will be the responsibility of investigators to keep in a safe place the information about the block received by the patients.
Intervention model description
The study will be conducted as a prospective, randomized, double blinded, parallel trial at the University of Pittsburgh Medical Center (UPMC) Shadyside Hospital.
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
1. Patients 18-90 years old 2. Patients undergoing nephrectomy 3. Body Mass Index 19-36 4. Male and Female 5. All races 6. American Society of Anesthesiologist scale I, II, III
Exclusion criteria
1. Patient refusal 2. Pregnancy 3. Non-English speaking or inability to participate in the study 4. Patients with coagulopathy or With International Normalized Ratio \>1,5 the day of the surgery. 5. Chronic steroid use 6. Chronic pain 7. Chronic opiate use
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| pain control over the next 72 hours after surgery: Visual analogue scale | 72 hours | Visual analogue scale (0-10) measurement |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| opioid consumption during the first 72 hours | 72 hours | opioid consumption in morphine milliequivalents during the first 72 hours |
| time of the first opioid consumption after surgery | 24 hours | time after surgery that patient takes to require opioid medication after surgery |
| 100 feet walking | 48 hours | time after surgery that the patient takes in order to be able to walk 100 feet |
| presence or absence of muscular weakness after Quadratus lumborum type 2 block | 24 hours | muscular weakness is associated sometime with femoral quadratus muscle weakness |
Countries
United States
Outcome results
None listed