Analgesia
Conditions
Keywords
spiral thighplasty , pain , nerve block
Brief summary
Whether trans muscular QLB provides postoperative analgesia compared with LPB after thigh lift surgery
Detailed description
Adequate analgesia after spiral thigh reduction (thigh lift) is essential for early mobilization and patient satisfaction. Quadratus lumborum block (QLB) has shown analgesic efficacy comparable to lumbar plexus block (LPB) for hip area surgery with potential advantages in motor-sparing and safety
Interventions
OTHERUltrasound-Guided Trans-muscular QLB
With the patient lateral decubitus position, a low-frequency curvilinear probe in the 'Shamrock' view at L2-L4. In-plane posterior-to-anterior needle advancement through the Quadratus lumborum to the interfascial plane anterior to QL and posterior to Psoas major. Inject 30 mL Bupivacaine 0.25% after negative aspiration and hydrodissection to confirm proper spread . Then the patient will be turned to the other side, and the block will be done with the same technique
OTHERUltrasound-Guided Posterior Lumbar Plexus (Psoas Compartment) Block
Lateral decubitus, Shamrock view to identify the Psoas compartment; in-plane needle advancement to the Psoas compartment adjacent to the transverse process. Inject 30 mL of Bupivacaine 0.25% in 5 mL increments, aspirating frequently. This will be done in the same position for both sides
Sponsors
Menoufia University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Masking description
Computer-generated randomization in variable blocks; allocation sealed in opaque envelopes. Blocks performed by an anesthesiologist not involved in postoperative assessment. Patients and outcome assessors are blinded. Drape and opaque dressings conceal injection sites for both groups to preserve blinding
Intervention model description
Prospective, randomized, parallel-group, double-blind, clinical trial. Primary endpoint: time for first analgesic request postoperatively. Key secondary endpoints: 24-hour opioid consumption (oral morphine equivalents), pain on movement at 6/12/24 hours, time to first ambulation, postoperative nausea/vomiting (PONV), block performance time, and block-related complications. Hypothesis: QLB is non-inferior to LPB for 24-hour pain scores and will yield less motor weakness
Eligibility
Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
* ASA ( American Society of Anaesthesia) I-II * elective bilateral spiral thigh lift under general anesthesia * consent to regional block and trial participation
Exclusion criteria
* Coagulopathy or therapeutic anticoagulation not meeting ASRA safety windows * infection at injection sites * allergy to local anesthetics * preexisting significant neuropathy * BMI \> 35 kg/m² if impeding ultrasound visualization; renal/hepatic failure; pregnancy; inability to use NRS; chronic opioid use \>60 mg oral morphine equivalents/day; contraindication to study analgesics.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Visual analogue scale score | 24 hours | Visual analogue scale score at 1st,6th,12th and 24 h (where 0 is interpreted as no pain, 1-4 mild pain, 5-6 moderate pain, 7-10 severe pain) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time for first analgesic request | 24 hours | first analgesic request |
| Opioid consumption | 24 hours | cumulative opioid consumption |
| Time to walk >30 (meter) | 24 hours | walk \>30 (meter) |
| Performance Time | minutes | block performance time |
| The number of patients who develop block-related complications | 24 hours | nausea and vomiting , hypotension |
| the patients Satisfaction questionnaire | 24 hours | pateints are either : Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied |
Countries
Egypt
Contacts
STUDY_DIRECTORAMAL G SAFAN, MD
Menoufia University
Outcome results
None listed