Anterior Quadratus Lumborum Block Versus Erector Spina Plane Block in Percutaneous Nephrolithotomy Surgery

NCT05822492 | Completed

• 1 other identifier: PNLESPQLB2022
• Study Type: observational
• Target: 90
• Locations: 1 country
• Sites: 1

Brief Summary

In this study, it was aimed to evaluate the effects of anterior quadratus lumborum block (QLB3) and Erector Spina Plane Block (ESPB) on postoperative acute pain scores and opioid consumption in the first 24 hours in Percutaneous Nephrolithotomy Surgery

Conditions

Anesthesia; Analgesia; Patient Controlled Analgesia; Quadratus Lumborum Block; Erector Spina Plane Block

Keywords

Anesthesia; Analgesia; Percutaneous Nephrolithotomy Surgery; Patient controlled analgesia; Anterior quadratus lumborum block; Erector spina plane block

Outcome Measures

Primary Outcomes (1)

• Morphine consumption in the first 24 hours after surgery

  Morphine consumption in the first 24 hours after surgery will be measured. Patients will be able to request opioids via a PCA device when their NRS score is ≥ 4.

  postoperative day 1

Secondary Outcomes (8)

• Postoperative pain scores

  postoperative day 1

• The postoperative nausea and vomiting (PONV) scores and the number of patients requiring antiemetic medication.

  postoperative day 1

• Intraoperative remifentanil consumption

  The remifentanil consumption will be recorded from anesthesia induction until the patient is referred to the recovery unit, up to 150 minutes.

• The number of patient required rescue analgesia

  postoperative day 1

• Time of first analgesic request

  postoperative day 1

Study Arms (3)

Group QLB3

Patients who applied the QLB3 block before PCNL surgery were included in this group.

Procedure: Group QLB3

Group ESPB

Patients who applied ESP block before PCNL surgery were included in this group.

Procedure: Group ESPB

Group Control

Patients who did not use any block before PCNL surgery were included in this group.

Other: Group Control

Interventions

Group QLB3 PROCEDURE

Patients who applied the QLB3 block before PCNL surgery were included in this group Multimodal analgesia protocol is applied to all patients undergoing PCNL surgery in our clinic. According to this protocol, patients are administered iv tenoxicam 20mg after induction of general anesthesia and iv paracetamol 1 gr intraoperatively. Postoperative analgesia: iv paracetamol 1gr every 8 hours and iv PCA of 0,2mg/ml morphine (the bolus dose is 20 mcg/kg, the lock-in time of 6-10 minutes, and the 4-hour limit is adjusted to be 80% of the calculated total dose). In cases where rescue analgesia is required (VAS score ≥4), 100 mg tramadol is administered to patients. The prophylaxis for postoperative nausea and vomiting (PONV) involved the routine administration of 8 mg IV dexamethasone to patients before induction and 0.15 mg/kg IV ondansetron 20 minutes before the end of the procedure.

Also known as: Anterior Quadratus Lumborum Block (QLB3)

Group QLB3

Group ESPB PROCEDURE

Patients who applied ESP block before PCNL surgery were included in this group Multimodal analgesia protocol is applied to all patients undergoing PCNL surgery in our clinic. According to this protocol, patients are administered iv tenoxicam 20mg after induction of general anesthesia and iv paracetamol 1 gr intraoperatively. Postoperative analgesia: iv paracetamol 1gr every 8 hours and iv PCA of 0,2mg/ml morphine (the bolus dose is 20 mcg/kg, the lock-in time of 6-10 minutes, and the 4-hour limit is adjusted to be 80% of the calculated total dose). In cases where rescue analgesia is required (VAS score ≥4), 100 mg tramadol is administered to patients. The prophylaxis for postoperative nausea and vomiting (PONV) involved the routine administration of 8 mg IV dexamethasone to patients before induction and 0.15 mg/kg IV ondansetron 20 minutes before the end of the procedure.

Also known as: Erector spina plane block (ESPB)

Group ESPB

Group Control OTHER

Patients who did not use block before PCNL surgery were included in this group. Multimodal analgesia protocol is applied to all patients undergoing PCNL surgery in our clinic. According to this protocol, patients are administered iv tenoxicam 20mg after induction of general anesthesia and iv paracetamol 1 gr intraoperatively. Postoperative analgesia: iv paracetamol 1gr every 8 hours and iv PCA of 0,2mg/ml morphine (the bolus dose is 20 mcg/kg, the lock-in time of 6-10 minutes, and the 4-hour limit is adjusted to be 80% of the calculated total dose). In cases where rescue analgesia is required (VAS score ≥4), 100 mg tramadol is administered to patients. The prophylaxis for postoperative nausea and vomiting (PONV) involved the routine administration of 8 mg IV dexamethasone to patients before induction and 0.15 mg/kg IV ondansetron 20 minutes before the end of the procedure.

Also known as: Control

Group Control

Eligibility Criteria

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

Study Population

Patients with undergoing percutaneous nephrolithotomy surgery,

You may qualify if:

• years
• American Society of Anesthesiology score I-III patients scheduled for unilateral PCNL in elective conditions
• Patients with BMI \<35 kg/m2

You may not qualify if:

• Pregnancy
• Conditions where regional anesthesia is contraindicated (coagulopathy, international normalized ratio abnormality, thrombocytopenia, infection at the injection site)
• History of hypersensitivity or allergy to local anesthetics
• Patients with psychiatric disorders
• Patients with musculoskeletal deformities
• Patients with alcohol-drug dependence
• Patients with cognitive dysfunction (patients incapable of evaluating the NRS score)
• Patients who did not give consent / did not want to participate

Sponsors & Collaborators

• Ondokuz Mayıs University: lead

Study Sites (1)

Ondokuz mayıs Universty

Samsun, 55060, Turkey (Türkiye)

Location

Related Publications (6)

• Dam M, Hansen CK, Poulsen TD, Azawi NH, Wolmarans M, Chan V, Laier GH, Bendtsen TF, Borglum J. Transmuscular quadratus lumborum block for percutaneous nephrolithotomy reduces opioid consumption and speeds ambulation and discharge from hospital: a single centre randomised controlled trial. Br J Anaesth. 2019 Aug;123(2):e350-e358. doi: 10.1016/j.bja.2019.04.054. Epub 2019 May 30.

  PMID: 31153628 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

• De Cassai A, Bonvicini D, Correale C, Sandei L, Tulgar S, Tonetti T. Erector spinae plane block: a systematic qualitative review. Minerva Anestesiol. 2019 Mar;85(3):308-319. doi: 10.23736/S0375-9393.18.13341-4. Epub 2019 Jan 4.

  PMID: 30621377 BACKGROUND

• Elsharkawy H. Quadratus Lumborum Blocks. Adv Anesth. 2017;35(1):145-157. doi: 10.1016/j.aan.2017.07.007. Epub 2017 Oct 3. No abstract available.

  PMID: 29103570 BACKGROUND

• Kilic E, Bulut E. Quadratus Lumborum Block III for Postoperative Pain After Percutaneous Nephrolithotomy. Turk J Anaesthesiol Reanim. 2018 Aug;46(4):272-275. doi: 10.5152/TJAR.2018.92331. Epub 2018 Aug 1.

  PMID: 30140533 BACKGROUND

• Turkan H, Kaya C, Turunc E, Dost B, Ustun YB. Effects of anterior quadratus lumborum block versus erector spinae plane block on postoperative acute pain in percutaneous nephrolithotomy: a prospective, observational study. BMC Anesthesiol. 2024 Sep 10;24(1):322. doi: 10.1186/s12871-024-02691-7.

  PMID: 39256675 DERIVED

MeSH Terms

Conditions

Agnosia

Interventions

Control Groups

Condition Hierarchy (Ancestors)

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

Intervention Hierarchy (Ancestors)

Epidemiologic Research Design; Epidemiologic Methods; Investigative Techniques; Research Design; Methods

Study Officials

• CENGIZ KAYA

  Ondokuz Mayıs University

  STUDY DIRECTOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator, Clinical Professor

Study Record Dates

• First Submitted: April 10, 2023
• First Posted: April 20, 2023
• Study Start: April 20, 2023
• Primary Completion: September 20, 2023
• Study Completion: September 30, 2023
• Last Updated: December 8, 2023

Record last verified: 2023-12

Locations

TU (1)