Bupivacaine, Dexmedetomidine, Laparoscopic Cholecystectomy, Postoperative Analgesia, Quadratus Lumborum Block, Ultrasound-Guided
Conditions
Brief summary
The aim of this study is to evaluate the effect of adding Dexmedctomidinc as adjuvant to Bubivacaine in Ultrasound-Guided Quadratus Lumborum Block for Postoperative Analgesia in Laparoscopic Cholecystectomy.
Detailed description
When compared to conventional surgery, laparoscopic cholecystectomy is less invasive and leads to less postoperative pain. However, the postoperative pain following laparoscopic cholecystectomy consists of both somatic and visceral components with pain originating from port entry' wounds, gallbladder resection and abdominal insufflation that leads to peritoneal distention and peritoneal damage. Quadratus lamborum block (QLB) is abdominal truncal block that provides both somatic and visceral analgesia for both upper and lower abdominal surgical procedures, It was first introduced by Blanco.Currently There are 4 approaches described for QLB: lateral, posterior, anterior and intramuscular. Transmuscular (anterior) QLB Type 3 block involves injection in the plane between the psoas major (PM) and the QL muscles studies have reported spread of the injectate to the thoracic paravertebral space, as well as the spinal nerve which runs anterior to the QL muscle
Interventions
DRUGBupivacaine
Patients received general anesthesia and bilateral ultrasound guided transmuscular quadratus lumborum block wilh (20 ml bupivacaine 0.25%).
DRUGBupivacaine and Dexmedetomidinc) group
Patients received general anesthesia and bilateral ultrasound guided transmuscular quadratus lumborum block with (20ml Bupivacaine 0.25%) + (Dexmedetomidine Imic/kg)
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Aged 21-65 years. * Both genders. * American society of Anesthesiology (ASA) class l, II undergoing elective laparoscopic cholecystectomy
Exclusion criteria
* Patient refusal * History of allergy to local anesthetic. * Liver or renal pathology affecting drug elimination * Menta!dysfunction or cognitive disorders. * Patients on chronic pain medications. * Body Mass Index \> 40 kg/m2. * Coagulopathy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total morphine consumption | 24 hours postoperatively | Intravenous morphine 2 mg given when numerical rating scale equal or above 4 as rescue analgesia |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Heart rate | At the end of the operation (Up to 48 min). | Heart rate was recorded before the block (base-line value), after skin incision by 5,15,30 minutes, and at the end of the operation. |
| lntraoperative fentanyl consumption | lntraoperatively | Additional fentanyl dosages of 0.5 µg/kg IV was administered if heart rate or mean arterial blood pressure elevated more than 20% of the baseline (after exclusion of other causes than pain). |
| Mean arterial blood pressure | At the end of the operation(Up to 48 min). | Mean arterial blood pressure was recorded before the block (base-line value), after skin incision by 5,15,30 minutes, and at the end of the operation. |
| Time to the first request for the rescue analgesia | 24 hours postoperatively | Time to the first request for the rescue analgesia (time from end of surgery to first dose of morphine administrated).IV morphine 2mg was given when NRS equal or above 4. |
| Incidence of Complication | 24 hours postoperatively | Complication such as bradycardia, hypotension, nausea, vomiting, Pruritis, respiratory depression, or any other complication. |
| Degree of pain score | 24 hours postoperatively | Postoperative pain was assessed by the numerical rating scale (NRS; 0 no pain while 10 is the maximum pain) immediately after discharge to the PACU and ward at 6, 12, 18, 24 hours. |
Countries
Egypt
Outcome results
None listed