Analgesia, Cholecystectomy, Nerve Block Duration, Nerve Blocks, Postoperative Pain, Postoperative Pain Management
Conditions
Keywords
postoperative pain, laparoscopic cholecystectomy, quadratus lumborum block, abdominal wall blocks, adjuvant, dexamethasone, postoperative analgesia
Brief summary
İn recent years abdominal wall blocks are widely used for to reduce intraoperative anesthetic recuirements and postoperative analgesia.Quadratus lumborum blocks are one of the abdominal wall blocks to used at laparoscopic cholecystectomy.Conventionally adjuvants used to improve and prolonged the effect of periferic nerve, spinal and abdominal blocks.İn this study investigators will evaluate the effectiveness of adjuvants at quatratus lumborum block at patient underwent laparoscopic cholecystectomy.
Detailed description
Laparoscopic approach in cholecystectomy surgery is frequently preferred because of its advantages in systemic complications, morbidity, mortality and hospital stay. Pain is one of the important causes of late discharge after surgery. Laparoscopic cholecystectomy surgery requires a multimodal analgesia approach because of its multiple pain components.Regional analgesia techniques are effective in reducing the side effects such as intraoperative opioid use, postoperative pain and nausea and vomiting. Quadratus lumborum III block is a regional technique performed for multimodal analgesia.Adjuvants are known to improve the analgesic efficacy and prolonge the effect of the periferic and central nerve blocks.The aim of this study is to determine the effectiveness of adding adjuvant at quadratus lumborum block for patients who underwent laparoscopic cholecystectomy.
Interventions
PROCEDUREAdjuvant-free Quadratus lumborum block
Patients are placed in the lateral decubitus position. The area where the block will be applied is disinfected with povidine iodine. A convex ultrasound probe is placed on the midaxillary line above the iliac crest. By visualizing the transverse process adjacent to the psoas major and quadratus lumborum muscles, using the in-plane technique, using a 22 gauge 80 mm peripheral block needle after negative aspiration into the anterior layer of the thoracolumbar fascia anterior to the quadratus lumborum muscle muscle, 0.5-1 ml of serum After observing hydrodissection with physiological, 20 ml of 0.25% bupivacaine is injected. The same is done to the opposite side.
PROCEDUREQuadratus lumborum block III with Adjuvant
The same block was applied to this group too, but a different local anesthetic mixture was used.Patients are placed in the lateral decubitus position. The area where the block will be applied is disinfected with povidine iodine. A convex ultrasound probe is placed on the midaxillary line above the iliac crest. By visualizing the transverse process adjacent to the psoas major and quadratus lumborum muscles, using the in-plane technique, using a 22 gauge 80 mm peripheral block needle after negative aspiration into the anterior layer of the thoracolumbar fascia anterior to the quadratus lumborum muscle muscle, 0.5-1 ml of serum After observing hydrodissection with physiological, 20 ml of 0.25% bupivacaine and 4mg dexamethasone is injected. The same is done to the opposite side.
Sponsors
Gaziosmanpasa Research and Education Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
American Society of Anesthesiologists physical statusⅠ-II
Exclusion criteria
* Inclusion Criteria: * 18-65 years of age * American Society of Anesthesiologists physical statusⅠ-II
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total amount of opioid requirements | within 24 hours after the surgery | The total tramadol use of the patients in 24 hours will be recorded. |
| rescue analgesia | within 24 hours after the surgery | The rescue analgesia requirement and time of the need of the rescue analgesia requirement |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| intraoperative remifentanil consumption | during operation procedure] | The total remifentanil use to be used in the maintenance of 0.05-0.2 mcg/kg remifentanil will be recorded by titration according to the hemodynamic data of the intraoperative patients. |
| Visual Analogue Scale values | at 1st, 4th,8th 12th and 24th hours after the surgery] | Visual Analogue Scale is a scale of 0-10 cm in length, expressed by non-standard verbal descriptors (no pain-unbearable pain..) indicating the limits of pain intensity on both sides, horizontally or vertically. |
| side effects such as nausea, vomiting and shoulder pain | within 24 hours after the surgery | The incidence of postoperative side effects such as nausea, vomiting and shoulder pain will be evaluated. |
Countries
Turkey (Türkiye)
Outcome results
None listed