Quadratus Lumborum Block vs Erector Spinal Block for Post Abdomen Surgery Analgesia

NCT05446727 | Completed DMC

• 1 other identifier: 1072.6120.32.2022
• Study Type: interventional
• Target: 100
• Locations: 1 country
• Sites: 1

Brief Summary

Prior to surgery, patients will be stratified into groups according to the type of surgical procedure. The anticipated groups are as follows: Patients with colorectal cancer Patients with prostate cancer Patients with renal cancer Patients undergoing surgery for gallbladder cholelithiasis. The Erector Spinal Block (ESP) is based on the deposition of the local anesthetic in the inter-fascial space between the dorsal extensor muscle and the intercostal muscles at the height of the transverse processes. The scope of the blockade covers the dorsal and ventral branches of the thoracic spinal nerves, but also in most cases the investigetors are able to obtain a wide distribution of the drug into the paravertebral space by "permeating" the local anesthetic through the fascial compartments. The clinical effect of the blockade is due to blocking the nerve structures of the paravertebral space (spinal nerve branches and the sympathetic trunk). The scope of the blockade, after its execution at the level of Th5, most often includes the segments from Th1 to L1. Currently, the Quadratus Lumborum block (QL block) is performed as one of the perioperative pain management procedures for all generations (pediatrics, pregnant, and adult) undergoing abdominal surgery. The local anesthetic injected via the approach of the anterior QL block ( QL1 block ) can more easily extend beyond the TAP to the thoracic paravertebral space or the thoracolumbar plane, the posterior QL block entails a broader sensory-level analgesic and may generate analgesia from T7 to L1.

Conditions

Pain, Acute; Postoperative Pain; Anesthetics, Local

Keywords

Anesthetics; Local Anesthetics

Outcome Measures

Primary Outcomes (1)

• Total long acting opioid consumption in oxycodone equivalents

  the total dosage of given drug

  1 days

Secondary Outcomes (2)

• Pain scores will be recorded at intervals. The Numerical Rating Scale (NRS) is an 11-point scale where 0 is no pain and 10 is the worst pain imaginable.

  1 days

• Incidence of postoperative nausea-vomiting; itching; local anesthetic toxicity;

  1vdays

Study Arms (2)

Quadratus Lumborum block group

EXPERIMENTAL

Experimental: Quadratus Lumborum block group Patients were placed in the lateral decubitus position. After skin disinfection, a linear high-frequency ultrasound probe guarded with a sterile cover was set above the iliac crest and shifted cranially until the three abdominal wall muscles were distinguished. Then, it was moved medially until latissimus dorsi and quadratus lumborum (QLM) muscles were shown within identical short-axis views. A 21-gauge needle was inserted from the edge of the probe using an in-plane technique and advanced into the fascia over the QLM. After ensuring negative aspiration for blood, 30 ml of 0.35% ropivacaine bilateral was injected slowly into the fascial interspace.

Drug: Ropivacaine injection

erector spinae planae block

EXPERIMENTAL

The ESP block was performed with the patient in a sitting position. After skin disinfection, a linear high-frequency (L14-6NS) ultrasound probe, covered with a sterile sheath, was positioned sagittally 1-2 cm lateral to the midline at the level of the ninth thoracic vertebra (T9). The T9 level was earlier identified by palpating the spinous process of the seventh cervical vertebra and counting down nine intervertebral spaces. After identifying the erector spinae muscle (ESM) and transverse process, a 21-gauge needle was inserted deep into the ESM in a cranio-caudal direction, using an in-plane technique. The needle was advanced, ensuring that it crossed all muscle layers until it contacted the transverse process. A total of 60 mL of 0.35% ropivacaine was given. This procedure was performed bilaterally on each patient.

Drug: Ropivacaine injection

Interventions

Ropivacaine injection DRUG

30ml of 0.35% ropivacaine bilaterally

Quadratus Lumborum block group; erector spinae planae block

Eligibility Criteria

• Age: 18 Years - 90 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients requiring abdomen surgery
• Patients of age 18 and over
• BMI \< 40
• Patients who are expected to stay in-hospital overnight after surgery

You may not qualify if:

• Patient refusal
• Contraindications to paravertebral blocks: Infection at the site of needle insertion, empyema, allergy to local anesthetic drugs, and tumor occupying the thoracic paravertebral space, coagulopathy, bleeding disorder or therapeutic anticoagulation
• Known allergy to local anesthetics
• Inability to provide informed consent
• Inability to use a PCA due to languate or comprehension barriers
• BMI \>= 40
• Any patient on opioids for greater than or equal to 3 months duration prior to surgery
• Patients with chronic pain syndromes

Sponsors & Collaborators

• Jagiellonian University: lead

Study Sites (1)

Jagiellonian University

Krakow, Maloposkie, 31-501, Poland

Location

Related Publications (1)

• Tomasz S, Pawel M, Michal C, Szpunar W, Jan S, Tomasz L, Anna K, Renata B, Olga S, Tomasz D, Michal T. Effects of Erector Spinae Plane Block and Quadratus Lumborum Block on Postoperative Opioid Consumption in Laparoscopic Kidney Surgery: A Randomized Controlled Clinical Trial. Pain Res Manag. 2025 Aug 4;2025:8869716. doi: 10.1155/prm/8869716. eCollection 2025.

  PMID: 40791636 DERIVED

MeSH Terms

Conditions

Acute Pain; Pain, Postoperative

Interventions

Ropivacaine

Condition Hierarchy (Ancestors)

Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Postoperative Complications; Pathologic Processes

Intervention Hierarchy (Ancestors)

Anilides; Amides; Organic Chemicals; Aniline Compounds; Amines

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: INVESTIGATOR
• Masking Details: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: June 2, 2022
• First Posted: July 7, 2022
• Study Start: May 1, 2022
• Primary Completion: May 6, 2022
• Study Completion: December 31, 2023
• Last Updated: September 4, 2025

Record last verified: 2023-06

Data Sharing

• IPD Sharing: Will not share

Locations

PL (1)