ESPB vs PVB vs QLB After Pelvi-ureteric Surgeries

NCT05713643 | Completed

• 1 other identifier: MKSU 50-12-12
• Study Type: interventional
• Target: 90
• Locations: 1 country
• Sites: 1

Brief Summary

The aim of this study is to compare the analgesic efficacy of erector spinae plane block versus thoracic paravertebral block versus quadratus lumborum block on postoperative analgesia after pelvi-ureteric surgeries.

Conditions

Erector Spinae Plane Block; Paravertebral Block; Quadratus Lumborum Block; Analgesia

Outcome Measures

Primary Outcomes (1)

• The total postoperative morphine consumption

  Total amount of rescue analgesic in the first 48 hours postoperative will be measured.

  48 hours postoperatively

Secondary Outcomes (3)

• Access post-operative pain scores

  48 hours Postoperatively

• Access time of first analgesic

  48 hours Postoperatively

• Patients' satisfaction after surgery.

  48 hours Postoperatively

Study Arms (3)

ESPB group

ACTIVE COMPARATOR

Procedure: ESPB Technique

TPVB group

ACTIVE COMPARATOR

Procedure: TPVB Technique

QLB group

ACTIVE COMPARATOR

Procedure: QLB Technique

Interventions

ESPB Technique PROCEDURE

The patient will be in sitting position. The probe will be positioned with longitudinal alignment, 3 cm lateral to the spinous procedure of T8 to obtain a parasagittal view. An echogenic needle will be introduced from the caudal end of the probe and advanced in-plane direction until the needle tip hit the tip of the transverse process. Bupivacaine will be afterwards injected into the erector spinae plane block. Linear spread cranially and caudally below the muscle upon injection will be visualized on the US screen indicating successful block.

ESPB group

TPVB Technique PROCEDURE

The patient will be in sitting position. The probe will be positioned with longitudinal alignment, 3 cm lateral and parallel to 8th spinous process till transverse process, superior costotransverse ligament, and pleura will be visualized then lateral tilt of the probe was done for better visualization of the PVS between the superior costotransverse ligament and the pleura. An echogenic needle was introduced at caudal end of transducer using the in-plane technique till piercing the superior costotransverse ligament . Bupivacaine will be injected into the PVS with downward displacement of the pleura indicating a successful block.

TPVB group

QLB Technique PROCEDURE

The patient will be in lateral position. The probe will be placed above the iliac crest. The Petit's triangle will be identified. The three abdominal muscles (i.e., the external oblique, internal oblique and transversus abdominus muscles) will be detected. Both the external oblique and internal oblique muscles will be followed posteriorly until the layers of the thoracolumbar fascia appear as a bright hyperechogenic line. The quadratus lumborum muscle appears below to the latissimus dorsi muscle. While performing the quadratus lumborum block, "Shamrock sign" is identified; the transverse process of L4 appears as a stem whereas the three muscles psoas muscle, quadratus lumborum muscle and erector spinae appear as the leaves. A 22G (50mm) needle was inserted using an in-plane technique along the posterior edge of the ultrasound probe in the anteromedial direction. The needle tip was placed between the quadratus lumborum muscle and the Erector spinae muscle.

QLB group

Eligibility Criteria

• Age: 21 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18-65 years
• Both genders
• American Society of Anesthesiologists (ASA) physical status I-III
• Undergoing elective pelvi-ureteric surgeries.

You may not qualify if:

• Body Mass Index \> 30 kg/m2.
• Contraindication of deep nerve block such as allergic to anesthetic drug, coagulation disorder, and infection at the injection site.
• Chronic opioids dependence or chronic pain over 3 months.
• Use of medication such as gabapentin-pregabalin could affect pain perception.
• Unable to communicate preoperatively due to severe dementia, language barrier, or neuropsychiatric disorder.
• Unable to perform nerve block procedure due to difficult anatomy through ultrasound scan.

Sponsors & Collaborators

• Kafrelsheikh University: lead

Study Sites (1)

Mohammad Fouad Algyar

Tanta, ElGharbiaa, 31511, Egypt

Location

MeSH Terms

Conditions

Agnosia

Condition Hierarchy (Ancestors)

Perceptual Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Lecturer of Anesthesiology, Surgical Intensive Care and Pain Medicine

Study Record Dates

• First Submitted: January 26, 2023
• First Posted: February 6, 2023
• Study Start: January 30, 2023
• Primary Completion: November 5, 2023
• Study Completion: November 5, 2023
• Last Updated: November 22, 2023

Record last verified: 2023-11

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP
• Time Frame: One year after the end of the study

Locations

EG (1)