Determination Of Dispersion In Ultrasound Guided Quadratus Lumborum Block In Cadavers

NCT03545295 | Unknown

• 1 other identifier: Quadratus Lumborum Block
• Study Type: interventional
• Target: 20
• Locations: 1 country
• Sites: 1

Brief Summary

Lumbar Quadrant Blockade is a recent analgesic technique consisting of the injection of local anesthetic around the lumbar square muscle. It was initially described as a technique for abdominal wall analgesia, but later studies have increased the range of indications for laparoscopic and lower limb surgeries. There are several techniques described but with differences in the literature at the point of injection and volume of anesthetic. The exact mechanism of visceral analgesia has not yet been determined. The objective of this study is to determine the dispersion of local anesthetic as a variable dependent on the volume of local anesthetic and injection site and elucidate the mechanisms of analgesia.

Conditions

Nerve Block

Outcome Measures

Primary Outcomes (1)

• Spread of coloring solution according to the volume injected

  Observation of coloring solution around the spinal nerves as they exit the vertebral foramen. Comparison of number of spinal nerves colored according to the volume injected.

  3 hours

Secondary Outcomes (2)

• Spread of coloring solution to the paravertebral space

  3 hours

• Comparison of spread of the coloring solution between QLB 2 and QLB3

  3 hours

Study Arms (6)

QLB 2 10ml

EXPERIMENTAL

The cadaver will receive an ultrasound- guided Quadratus Lumborum Block type 2 with 10 ml coloring solution

Procedure: Quadratus Lumborum Block type 2

QLB 2 20ml

EXPERIMENTAL

The cadaver will receive an ultrasound- guided Quadratus Lumborum Block type 2 with 20 ml coloring solution

Procedure: Quadratus Lumborum Block type 2

QLB 2 30ml

EXPERIMENTAL

The cadaver will receive an ultrasound- guided Quadratus Lumborum Block type 2 with 30 ml coloring solution

Procedure: Quadratus Lumborum Block type 2

QLB 3 10ml

EXPERIMENTAL

The cadaver will receive an ultrasound- guided Quadratus Lumborum Block type 3 with 10 ml coloring solution

Procedure: Quadratus Lumborum Block type 3

QLB 3 20ml

EXPERIMENTAL

The cadaver will receive an ultrasound- guided Quadratus Lumborum Block type 3 with 20 ml coloring solution

Procedure: Quadratus Lumborum Block type 3

QLB 3 30ml

EXPERIMENTAL

The cadaver will receive an ultrasound- guided Quadratus Lumborum Block type 3 with 30 ml coloring solution

Procedure: Quadratus Lumborum Block type 3

Interventions

Quadratus Lumborum Block type 2 PROCEDURE

Ultrasound guided injection of coloring solution using a 18g Tuohy echogenic needle, posterior to the Quadratus Lumborum muscle

QLB 2 10ml; QLB 2 20ml; QLB 2 30ml

Quadratus Lumborum Block type 3 PROCEDURE

Ultrasound guided injection of coloring solution using a 18g Tuohy echogenic needle, anterior to the Quadratus Lumborum muscle

QLB 3 10ml; QLB 3 20ml; QLB 3 30ml

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Fresh corpses - not subjected to a formaldehyde process or frozen for more than 24 hours
• Age ≥ 18 years.
• Free, informed and informed consent signed by relatives or guardians of the body.
• Height\> 150 cm and \<190 cm

You may not qualify if:

• Previous spinal surgery.
• Significant spinal deformity
• Body mass index (BMI) ≥ 35 kg / m2
• Absence of relatives or guardians who can sign the written consent

Sponsors & Collaborators

• Federal University of São Paulo: lead
• Irmandade da Santa Casa de Misericordia de Sao Paulo: collaborator

Study Sites (1)

Irmandade de Misericórdia da Santa Casa De São Paulo

São Paulo, São Paulo, 01221020, Brazil

Location

Related Publications (16)

• Blanco R, Ansari T, Riad W, Shetty N. Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Pain After Cesarean Delivery: A Randomized Controlled Trial. Reg Anesth Pain Med. 2016 Nov/Dec;41(6):757-762. doi: 10.1097/AAP.0000000000000495.

  PMID: 27755488 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

• 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

• Tamura T, Kitamura K, Yokota S, Ito S, Shibata Y, Nishiwaki K. Spread of Quadratus Lumborum Block to the Paravertebral Space Via Intramuscular Injection: A Volunteer Study. Reg Anesth Pain Med. 2018 May;43(4):372-377. doi: 10.1097/AAP.0000000000000735.

  PMID: 29389680 BACKGROUND

• Wahal C, Kumar A, Pyati S. Advances in regional anaesthesia: A review of current practice, newer techniques and outcomes. Indian J Anaesth. 2018 Feb;62(2):94-102. doi: 10.4103/ija.IJA_433_17.

  PMID: 29491513 BACKGROUND

• Elsharkawy H, El-Boghdadly K, Kolli S, Esa WAS, DeGrande S, Soliman LM, Drake RL. Injectate spread following anterior sub-costal and posterior approaches to the quadratus lumborum block: A comparative cadaveric study. Eur J Anaesthesiol. 2017 Sep;34(9):587-595. doi: 10.1097/EJA.0000000000000680.

  PMID: 28731927 BACKGROUND

• Dam M, Moriggl B, Hansen CK, Hoermann R, Bendtsen TF, Borglum J. The Pathway of Injectate Spread With the Transmuscular Quadratus Lumborum Block: A Cadaver Study. Anesth Analg. 2017 Jul;125(1):303-312. doi: 10.1213/ANE.0000000000001922.

  PMID: 28277325 BACKGROUND

• Hernandez MA, Vecchione T, Boretsky K. Dermatomal spread following posterior transversus abdominis plane block in pediatric patients: our initial experience. Paediatr Anaesth. 2017 Mar;27(3):300-304. doi: 10.1111/pan.13034. Epub 2017 Jan 18.

  PMID: 28098413 BACKGROUND

• Oksuz G, Bilal B, Gurkan Y, Urfalioglu A, Arslan M, Gisi G, Oksuz H. Quadratus Lumborum Block Versus Transversus Abdominis Plane Block in Children Undergoing Low Abdominal Surgery: A Randomized Controlled Trial. Reg Anesth Pain Med. 2017 Sep/Oct;42(5):674-679. doi: 10.1097/AAP.0000000000000645.

  PMID: 28759502 BACKGROUND

• Ishio J, Komasawa N, Kido H, Minami T. Evaluation of ultrasound-guided posterior quadratus lumborum block for postoperative analgesia after laparoscopic gynecologic surgery. J Clin Anesth. 2017 Sep;41:1-4. doi: 10.1016/j.jclinane.2017.05.015. Epub 2017 Jun 1.

  PMID: 28802593 BACKGROUND

• Ueshima H, Otake H. RETRACTED: Clinical experiences of unilateral anterior sub-costal quadratus lumborum block for a nephrectomy. J Clin Anesth. 2018 Feb;44:120. doi: 10.1016/j.jclinane.2017.11.031. Epub 2017 Nov 29. No abstract available.

  PMID: 29195100 BACKGROUND

• Ueshima H, Hiroshi O. RETRACTED: Lumbar vertebra surgery performed with a bilateral posterior quadratus lumborum block. J Clin Anesth. 2017 Sep;41:61. doi: 10.1016/j.jclinane.2017.06.012. Epub 2017 Jul 3. No abstract available.

  PMID: 28802611 BACKGROUND

• Ben-David B, La Colla L. Extravasated Fluid in Hip Arthroscopy and Pain: Is Quadratus Lumborum Block the Answer? Anesth Analg. 2017 Jul;125(1):364. doi: 10.1213/ANE.0000000000002198. No abstract available.

  PMID: 28609336 BACKGROUND

• Gehling M, Tryba M. Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia. 2009 Jun;64(6):643-51. doi: 10.1111/j.1365-2044.2008.05817.x.

  PMID: 19462494 BACKGROUND

• Jeng CL, Torrillo TM, Rosenblatt MA. Complications of peripheral nerve blocks. Br J Anaesth. 2010 Dec;105 Suppl 1:i97-107. doi: 10.1093/bja/aeq273.

  PMID: 21148659 BACKGROUND

• Ueshima H, Otake H. RETRACTED: Lower limb amputations performed with anterior quadratus lumborum block and sciatic nerve block. J Clin Anesth. 2017 Feb;37:145. doi: 10.1016/j.jclinane.2016.12.026. Epub 2017 Jan 10. No abstract available.

  PMID: 28235508 BACKGROUND

Study Officials

• Marilia Tassinari Gonçalves Preza, MD

  Post Graduate

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Marcelo V Perez, PhD

CONTACT

+551121767000; marcelovazperez@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Médico Assistente

Model Details: the cadavers will be randomized to receive the intervention (Quadratus Lumborum Block) by different techniques (QLB 2/ QLB3) and different volumes (10, 20, 30 ml)

Study Record Dates

• First Submitted: May 12, 2018
• First Posted: June 4, 2018
• Study Start: August 1, 2018
• Primary Completion: April 30, 2019
• Study Completion: May 31, 2019
• Last Updated: June 4, 2018

Record last verified: 2018-05

Data Sharing

• IPD Sharing: Will not share

Locations

BR (1)