Ultrasound Guided Quadratus Lumborum Block for Postoperative Pain in Abdominoplasty

NCT02932930 | Completed

• 1 other identifier: USJ-02
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

The original concept of a quadratus lumborum block (QLB) indicated for analgesia after abdominal surgery was first described by Blanco in 2007. Also referred to as a posterior transversus abdominis plane (TAP) block, the QLB consists in deposition of local anesthetic on either the posterior or the anterolateral border of the quadratus lumborum muscle. TAP blocks have already been proved effective in urologic, abdominal, and gynecologic procedures by blocking the sensory nerve supply to the anterior abdominal wall thus reducing the amount of postoperative analgesic medication. The main advantages of QLB compared to the TAP block is a wider sensory block area and a longer duration of analgesia. This is due to the extension of local anesthetic agents beyond the TAP plane to the thoracic paravertebral space(4). Previous reports have shown that QLB is effective in providing pain relief after various abdominal operations. However, there are no published reports on QLB for postoperative pain after abdominoplasty. This prospective, randomized, double-blinded, controlled study aims to evaluate the analgesic efficacy, opioids consumption and quality of recovery of QLB in patients undergoing abdominoplasty. Patients scheduled to have abdominoplasty will be randomized to receive bilateral QLB with either ropivacaine 0.2% or normal saline. Post-operative cumulative analgesic medication consumption, pain severity at rest and on movement, as well as quality of recovery will be evaluated and compared in both groups.

Conditions

Pain

Keywords

QLB; Abdominoplasty; Quadratus lumborum block

Outcome Measures

Primary Outcomes (1)

• Cumulative morphine consumption

  Cumulative morphine consumption in mg while in the PACU and tramadol dose till 48 hour post operatively.

  up to 48 hour

Secondary Outcomes (7)

• Time to first tramadol dose

  up to 48 hour

• Postoperative pain severity

  up to 48 hour

• Postoperative dynamic pain severity

  up to 48 hour

• Nausea or vomiting

  up to 48 hour

• Sedation level

  up to 48 hour

Study Arms (2)

QLB group

ACTIVE COMPARATOR

Patients will receive at the beginning of the surgery 0.2 ml/kg of 0.2% ropivacaine bilaterally. Procedure: Quadratus Lumborum Block type II, local anesthetic injection on the posterior border of the quadratus lumborum muscle Drug: Ropivacaine, 0.2 ml/kg of 0.2% ropivacaine

Procedure: QLB bloc; Drug: 0.2% Ropivacaine

Control group

PLACEBO COMPARATOR

Patients will receive at the beginning of the surgery 0.2 ml/kg of 0.9% normal saline bilaterally. Procedure: Quadratus Lumborum Block type II, local anesthetic injection on the posterior border of the quadratus lumborum muscle Drug: Normal saline, 0.2 ml/kg of 0.9 % normal saline

Procedure: QLB bloc; Drug: 0.9% normal saline

Interventions

QLB bloc PROCEDURE

Control group; QLB group

0.2% Ropivacaine DRUG

0,2ml/kg of 0,2% ropivacaine

QLB group

0.9% normal saline DRUG

0,2ml/kg of 0.9% normal saline

Control group

Eligibility Criteria

• Sex: female
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Standard abdominoplasty procedure
• Written informed consent
• Age ≥ 18 years
• Female

You may not qualify if:

• Patient's refusal
• Allergies to any study medication
• Inability to comprehend or participate in scoring scales
• Deformations that could possibly affect the spread of the local anesthetic in the quadratus lumborum muscle plane
• Quadratus lumborum muscle plane not seen in ultrasound examination
• Coagulopathy or on anticoagulants

Sponsors & Collaborators

• St Joseph University, Beirut, Lebanon: lead

Study Sites (1)

Hotel Dieu De France

Beirut, Aschrafieh, 00961, Lebanon

Location

Related Publications (7)

• El-Boghdadly K, Elsharkawy H, Short A, Chin KJ. Quadratus Lumborum Block Nomenclature and Anatomical Considerations. Reg Anesth Pain Med. 2016 Jul-Aug;41(4):548-9. doi: 10.1097/AAP.0000000000000411. No abstract available.

  PMID: 27315184 BACKGROUND

• Hockett MM, Hembrador S, Lee A. Continuous Quadratus Lumborum Block for Postoperative Pain in Total Hip Arthroplasty: A Case Report. A A Case Rep. 2016 Sep 15;7(6):129-31. doi: 10.1213/XAA.0000000000000363.

  PMID: 27513972 BACKGROUND

• Sforza M, Andjelkov K, Zaccheddu R, Nagi H, Colic M. Transversus abdominis plane block anesthesia in abdominoplasties. Plast Reconstr Surg. 2011 Aug;128(2):529-535. doi: 10.1097/PRS.0b013e31821e6f51.

  PMID: 21788846 BACKGROUND

• Murouchi T, Iwasaki S, Yamakage M. Quadratus Lumborum Block: Analgesic Effects and Chronological Ropivacaine Concentrations After Laparoscopic Surgery. Reg Anesth Pain Med. 2016 Mar-Apr;41(2):146-50. doi: 10.1097/AAP.0000000000000349.

  PMID: 26735154 BACKGROUND

• Baidya DK, Maitra S, Arora MK, Agarwal A. Quadratus lumborum block: an effective method of perioperative analgesia in children undergoing pyeloplasty. J Clin Anesth. 2015 Dec;27(8):694-6. doi: 10.1016/j.jclinane.2015.05.006. Epub 2015 Jul 11. No abstract available.

  PMID: 26174113 BACKGROUND

• Blanco R, Ansari T, Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: A randomised controlled trial. Eur J Anaesthesiol. 2015 Nov;32(11):812-8. doi: 10.1097/EJA.0000000000000299.

  PMID: 26225500 BACKGROUND

• Chakraborty A, Goswami J, Patro V. Ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a pediatric patient. A A Case Rep. 2015 Feb 1;4(3):34-6. doi: 10.1213/XAA.0000000000000090.

  PMID: 25642956 BACKGROUND

MeSH Terms

Conditions

Pain

Interventions

Ropivacaine; Saline Solution

Condition Hierarchy (Ancestors)

Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Anilides; Amides; Organic Chemicals; Aniline Compounds; Amines; Crystalloid Solutions; Isotonic Solutions; Solutions; Pharmaceutical Preparations

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: MD

Study Record Dates

• First Submitted: October 10, 2016
• First Posted: October 13, 2016
• Study Start: October 1, 2016
• Primary Completion: June 1, 2019
• Study Completion: August 1, 2019
• Last Updated: December 13, 2019

Record last verified: 2019-12

Locations

LE (1)