Elective Major Abdominal Surgery
Conditions
Brief summary
Acute postoperative pain is an important issue after major abdominal surgeries for which different analgesic modalities have been tried. Epidural analgesia is the recommended technique to relieve pain after major abdominal surgeries owing to the proved superior analgesia, reduction of opioid-related side effects as nausea, vomiting, pruritis and sedation, earlier recovery of bowel function and earlier ability for postoperative mobility. However, it is not without complications. Quadratus lumborum block is an ultrasound-guided block that provides patients with both visceral and somatic blockade. It lessens the potential risks associated with neuraxial techniques, so it may represent a novel alternative approach for analgesia after major abdominal surgeries.
Detailed description
The aim of this study is to detect the feasibility of ultra-sound guided bilateral quadratus lumborum block as a postoperative analgesic modality after major abdominal surgery in comparison to epidural block and its effects on total rescue analgesic requirements in the 1st postoperative 24hours, time to first analgesic request, pain VAS scores, intraoperative and postoperative hemodynamics and postoperative opioid-related side effects. Under complete aseptic conditions, the patients will receive either thoracic epidural block or bilateral ultrasound-guided quadratus lumborum block after induction of general anaesthesia
Interventions
Patients who will be subjected to epidural block will be placed in the lateral position then, after sterilization of the skin, 21 G spinal needle will be inserted at T9-T11 intervertebral spaces. The epidural space will be located using the loss of resistance to air technique and a mixture of bupivacaine 0.25% + 50 μ fentanyl targeting T6 level will be injected following induction of general anaesthesia.
OTHERUltrasound-guided bilateral quadratus lumborum block
Patients who will be subjected to major abdominal surgeries will be placed in a supine position with a pillow under their side to obtain an appropriate view of quadratus lumborum muscle. After sterilization of the skin and ultrasound-guided identification of the quadratus lumborum muscle, 20 ml bupivacaine 0.25% + 25μ fentanyl will be injected on each side following induction of general anaesthesia
DRUGInduction of general anaesthesia with propofol
propofol: 1.5-2.5mg/Kg
DRUGMuscle Relaxant
Atracurium : 0.5mg/Kg.
DRUGMaintenance of general anaesthesia
Sevoflurane 0.7-1.5 MAC in 40% oxygen
Sponsors
Mansoura University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Masking description
Single blind study
Intervention model description
Single blind study
Eligibility
Sex/Gender
ALL
Age
20 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists (ASA) physical status I-III
Exclusion criteria
* Patient's refusal * Significant cardiac, disease. * Significant hepatic disease. * Significant renal disease (serum creatinine ˃ 1.5 mg/dl). * Patients with drug abuse * Allergy to study medications * Mental disease * Communication barrier. * Coagulopathy. * Local skin infection
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Postoperative 24 hours cumulative rescue morphine consumption | For 24 hours after surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain score at rest | For 24 hours after surgery | Visual analogue scale to assess the severity of postoperative pain (0 mm for no pain and100 mm for worst imaginable pain) |
| Postoperative pain score on movement | For 24 hours after surgery | Visual analogue scale to assess the severity of postoperative pain (0 mm for no pain and100 mm for worst imaginable pain) |
| Postoperative pain score on cough | For 24 hours after surgery | Visual analogue scale to assess the severity of postoperative pain (0 mm for no pain and100 mm for worst imaginable pain) |
| Systolic blood pressure | For 28 hours after induction of anesthesia | — |
| The duration of postoperative analgesia | For 24 hours after surgery | time from performing epidural or quadratus lumborum block till the time for the first rescue morphine request |
| Mean blood pressure | For 28 hours after induction of anesthesia | — |
| Heart rate | For 28 hours after induction of anesthesia | — |
| Degree of postoperative nausea and vomiting | For 24 hours after surgery | Nausea will be measured using a numerical rating system (none= 0; mild= 1; moderate= 2; severe= 3). The number of vomiting episodes and the number of antiemetics received will be recorded |
| Pruritis | For 24 hours after surgery | — |
| Diastolic blood pressure | For 28 hours after induction of anesthesia | — |
Countries
Egypt
Outcome results
None listed