Quadratus Lumborum Block, Thoracolumbar Interfascial Plane Block, Local Anesthetic Infiltration, Lumbar Spine Fixation
Conditions
Brief summary
This study aimed to compare the efficacy of ultrasound guided trans-muscular quadratus lumborum Block, thoracolumbar interfascial plane block and local anesthetic infiltration for elective lumbar spine fixation undergo up to three-level fixation.
Detailed description
Back and leg pain arising from lumbar spine surgery is widespread, and its treatment can range from pharmacotherapy to surgical intervention. A majority of patients who undergo spinal surgery report experiencing moderate pain six months after the operation. Interfascial plane blocks, including the thoracolumbar interfascial plane (TLIP) block target these posterior rami passing through the paraspinal muscles. Several studies have explored the analgesic efficacy of TLIP block in posterior lumbar spine surgery. Quadratus lumborum block (QLB) is a posterior abdominal wall fascial block where local anesthetic is administered around QL muscle. play a significant role in contemporary medical practice for enhancing post-spinal surgery pain management. Local infiltrative analgesia applied in layers of the surgical wound layers has been suggested as an appealing alternative due to its simplicity, enhanced safety, and limited cost, also a popular modality for postoperative analgesia in spine surgery.
Interventions
OTHERQuadratus lumborum block
Patients received general anesthesia and bilateral ultrasound guided trans-muscular quadratus lumborum block (QLB 3) with (20 ml Bupivacaine 0.25% each side) + (Dexmedetomidine 0.5 mic/kg) for each side as total volume (1 mic/kg).
Patients received general anesthesia and bilateral ultrasound guided thoracolumbar interfascial plane block with (20ml of Bupivacaine 0.25%) for each side + (Dexmedetomidine 0.5 mic/kg) for each side as total volume (1 mic/kg).
Patients received general anesthesia and local anesthetic infiltration at the side of incision before with (40 ml of Bupivacaine 0.25%) + (Dexmedetomidine 1mic/kg).
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age from 18 to 65 years. * Both genders. * American Society of Anesthesiology (ASA) class I - II. * Scheduled for elective lumbar spine fixation up to three level.
Exclusion criteria
* Patient refusal. * History of allergy to local anesthetic. * Mental dysfunction or cognitive disorders. * Body Mass Index \> 30 kg/m2. * Coagulopathy. * Pregnancy. * Infections to the site of the block.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total morphine consumption | 24 hours postoperatively | Intravenous morphine (0.05mg/kg) was given when numeric rating scale (NRS) equal or above 4. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean arterial pressure | Till end of surgery (Up to 2 hours) | Mean arterial pressure was recorded before induction of anesthesia (base-line value), after prone position, at the time of skin incision and after skin incision by 5,15 and 30 minutes, and at the end of the operation. |
| Heart rate | Till end of surgery (Up to 2 hours) | Heart rate was recorded before induction of anesthesia (base-line value), after prone position, at the time of skin incision and after skin incision by 5,15 and 30 minutes, and at the end of the operation. |
| Time to the first request for rescue analgesia | 24 hours postoperatively | Time to the first request for rescue analgesia was recorded from the end of surgery till first dose of morphine administrated. |
| Degree of pain | 24 hours postoperatively | Each patient was instructed about postoperative pain assessment with the numeric rating scale (NRS) score. NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). NRS were the 0th (PACU), 1th, 3rd, 6th, 12th, and 24th postoperative hours. |
Countries
Egypt
Outcome results
None listed