Pain, Postoperative
Conditions
Keywords
anterior quadratus lumborum block, postoperative pain, adjuvant, dexamethasone, inguinal hernia
Brief summary
Evaluation of Postoperative Analgesic Efficacy of Adjuvant Use in Quadratus Lumborum Blocks
Detailed description
primary aim : Compare the time to first rescue analgesia in patients following the application of non-adjuvant Quadratus Lumborum Block and adjuvant Quadratus Lumborum Block for postoperative analgesia after inguinal hernia surgeries performed under spinal anesthesia. secondary aims are to: to compare and evaluate the total analgesic consumption over 24 hours Compare NRS (Numerical Rating Scale) values (at rest and dynamic) in patients during postoperative follow-ups at 4, 8, 12, and 24 hours. Compare side effects such as postoperative nausea and vomiting. In trunk blocks, local anesthesia is applied to the interfascial area between the abdominal wall or back muscles. Local anesthetics and steroids are used for this purpose. The analgesic efficacy of steroids is known from their perineural applications. Due to the lack of blood circulation and vascularization in the interfascial area, the absorption of local anesthetics is slow, providing prolonged analgesic effects. Trunk blocks applied in these regions are used as part of multimodal analgesia. The effectiveness of trunk blocks may vary based on the patient's anatomical differences and previous surgeries, but analgesic efficacy is generally observed for an average of 8-12 hours. the investigators believe that with the use of adjuvants, these durations will be extended, and analgesic efficacy will increase. In this study, it is planned to add a total of 8 mg of dexamethasone to the local anesthetic agent for patients undergoing adjuvant anterior Quadratus Lumborum Block. In studies conducted in the field of trunk blocks, the expected duration of analgesia is an average of 8-12 hours. In this study, the block application is planned to be preoperative. Dexamethasone was chosen as an adjuvant to extend the expected analgesia duration of 8-12 hours and to increase analgesic efficacy. Dexamethasone is known to be effective and safe when used as an adjuvant in all nerve blocks. To reduce opioid-related side effects such as nausea, vomiting, itching, constipation, and dependence associated with opioid medications used in postoperative analgesia for inguinal hernia surgeries, opioid-sparing analgesia and regional techniques are being employed. Quadratus Lumborum Blocks are being safely and easily performed and are frequently preferred in abdominal surgery due to recent advancements in trunk block techniques and ultrasound technology. This study aims to evaluate the postoperative analgesic efficacy of adjuvant and non-adjuvant anterior Quadratus Lumborum Blocks in patients undergoing inguinal hernia surgery. The investigators predict that the analgesic efficacy of the adjuvant Quadratus Lumborum Block will be more effective and longer-lasting.
Interventions
PROCEDUREANTERİOR 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.
PROCEDUREANTERİOR QUADRATUS LUMBORUM BLOCK WİTH ADJUVANT
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 8 mg de-xamethasone are injected.
Sponsors
Gaziosmanpasa Research and Education Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Masking description
Everyone except the person preparing the medication for the patient will be blinded. The person performing the block, the participants, and those monitoring during the postoperative period will be blinded to the study.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
- 18-65 years, American Society of Anesthesiologists physical statusⅠ-II -
Exclusion criteria
* local anesthetic allergy * Infection at the procedure site * Body Mass Index \>35 kg/m2 * Anticoagulant use with bleeding disorder * Chronic analgesia and opioid use -with mental and psychiatric disorders -
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| time to first rescue analgesic requirement. | 24 hour | Compare the time to first rescue analgesia in patients |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total analgesic Consumption | 24 hour | Our primary aim is to compare and evaluate the total analgesic consumption(diclofenac) over 24 hours following the application of non-adjuvant Quadratus Lumborum Block and adjuvant Quadratus Lumborum Block for postoperative analgesia after inguinal hernia surgeries performed under spinal anesthesia. |
| To compare the NRS (Numering rating scale) values (resting and dynamic) at 4. 8. 12 . 24. hours in the postoperative follow-up of the patients | 24 hour | Compare NRS (Numerical Rating Scale) values (at rest and dynamic) in patients during . postoperative follow-ups at 4, 8, 12, and 24 hoursAssessed at various time points to quantify pain intensity at rest and during movement. The Numerical Rating Scale (NRS) is a pain assessment tool where patients rate their pain from 0 (no pain) to 10 (worst pain). |
| To compare postoperative side effects such as nausea, vomiting | 24 hour | To compare postoperative side effects such as nausea, vomiting, quadriceps weakness |
Countries
Turkey (Türkiye)
Outcome results
None listed