Ultrasound-guided Erector Spinae Block Versus Quadratus Lumborum Block for Laparotomies

NCT04965194 | Completed

• 1 other identifier: 50:6/2021
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

The study aimed to compare the effect of ESP block and QL block in preventing postoperative pain and decreasing analgesic consumption in patients scheduled for laparotomies. This prospective randomized controlled study will be done after obtaining ethics committee's permission and written informed consent of the patients 60 adult patients aged 18-60 years scheduled for open laparotomies under general anesthesia will be included in this study. According to the used technique, the patients will be randomly allocated into 3 parallel equal groups (20 patients in each one). Group I (ES group): the patients will receive bilateral ESP block. Group II (QL group): the patients will receive bilateral QL block. Group III (control group): the patients will not receive any regional block.

Conditions

Analgesia

Keywords

ESPB; QLPB; analgesia; postoperative pain

Outcome Measures

Primary Outcomes (1)

• Total analgesic consumption

  total fentanyl consumption as rescue analgesia

  24 hours

Secondary Outcomes (3)

• Time of first analgesic request.

  24 hours

• dynamic Visual analogue pain score

  24 hours

• resting Visual analogue pain score

  24 hours

Study Arms (3)

Erector spinae plane block (ESPB)

EXPERIMENTAL

20 ml of 0.25% bupivacaine will be administered to perform ESP block on each side

Procedure: erector spinae plane block

Quadratus lumborum plane block (QLPB)

EXPERIMENTAL

The injectate (20ml of bupivacaine 0.25%) should ideally spread from the injection site inside the fascial plane between the QL and psoas major muscles to the thoracic paravertebral space with a goal to accomplish segmental somatic and visceral analgesia from T4 to L1.

Procedure: Quadratus lumborum plane block

Control group

PLACEBO COMPARATOR

patients received no regional block

Other: placebo

Interventions

erector spinae plane block PROCEDURE

Superficial probe will be placed 2-3 cm lateral to the spine using a sagittal approach at the level of T8. After identification of erector spinae muscle and transverse processes, the needle will be inserted deeply into the erector spinae muscle. Correct position of the needle tip is confirmed with administration of 0.5-1 ml of local anesthetic (LA), and 20 ml of 0.25% bupivacaine will be administered to perform ESP block. LA spread to both cranial and caudal directions will be seen.

Erector spinae plane block (ESPB)

Quadratus lumborum plane block PROCEDURE

A curved array transducer for the transmuscular QL (TQL) nerve block is placed in the axial plane on the patient's flank just cranial to the iliac crest. The "shamrock sign" is visualized: The transverse process of vertebra L4 is the stem, whereas the erector spinae posteriorly, QL laterally, and psoas major anteriorly represents the three leaves of the trefoil. The target for injection is the fascial plane between the QL and psoas major muscles. The needle is inserted using an in-plane technique from the posterior end of the transducer through the QL muscle. The injectate (20ml of bupivacaine 0.25%) should ideally spread from the injection site inside the fascial plane between the QL and psoas major muscles to the thoracic paravertebral space with a goal to accomplish segmental somatic and visceral analgesia from T4 to L1.

Quadratus lumborum plane block (QLPB)

placebo OTHER

patients received no regional block

Control group

Eligibility Criteria

• Age: 18 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Aged 18-60 years.
• ASA I-II.
• Both sexes.
• Open laparotomies.

You may not qualify if:

• Patient refusal
• Allergy to local anesthetics
• BMI \>40 kg/m2
• Bleeding diathesis or history of anticoagulant use.
• Psychiatric diseases.
• Infection of the skin at the site of needle punctures area.

Sponsors & Collaborators

• Minia University: lead

Study Sites (1)

Minia University Hospital

Minya, Minya Governorate, 61111, Egypt

Location

MeSH Terms

Conditions

Agnosia; Pain, Postoperative

Condition Hierarchy (Ancestors)

Perceptual Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Postoperative Complications; Pathologic Processes; Pain

Study Officials

• Shadwa R Mohamed, MD

  Mina university hospital

  STUDY CHAIR

• Ahmed H Mohamed

  Minia Universiry hospital

  STUDY DIRECTOR

Study Design

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

Study Record Dates

• First Submitted: July 3, 2021
• First Posted: July 16, 2021
• Study Start: July 15, 2021
• Primary Completion: April 1, 2022
• Study Completion: May 1, 2022
• Last Updated: November 4, 2022

Record last verified: 2022-11

Data Sharing

• IPD Sharing: Will not share

Locations

EG (1)