QLB vs ESPB for Lumbar Spinal Surgery

NCT06477198 | Completed

• 1 other identifier: Medipol Hospital 37
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Ultrasound-guided quadratus lumborum block (QLB) is a fascial plane block where local anesthetic is injected adjacent to the quadratus lumborum muscle to anesthetize the thoracolumbar nerves. The ultrasound (US) guided erector spina plane block (ESPB) is a novel interfacial plan block defined by Forero et al. at 2016. Visualization of sonoanatomy with US is easy, and the spread of local anesthesic agents can be easily seen under the erector spinae muscle. Thus, analgesia occurs in several dermatomes with cephalad-caudad way. It has been reported that ESPB provides lumbar analgesia at T10-12, L3. This study aims to compare US-guided ESPB and posterior QLB for postoperative analgesia management after lumbar disc herniation-laminectomy surgery.

Conditions

Lumbar Disc Herniation

Keywords

Lumbar Disc Herniation; Postoperative pain management; Erector spinae plane block; Quadratus lumborum block

Outcome Measures

Primary Outcomes (1)

• Postoperative pain scores (NRS-Numerical Rating Scala)

  Difference in the NRS scores at postoperative 2 hours between the groups

  Postoperative 2 hours period

Secondary Outcomes (4)

• The use of rescue analgesia (number of participants) (frequency of rescue analgesia)

  Postoperative 24 hours period

• The use of rescue analgesia (rate of tramadol using) (total consumption)

  Postoperative 24 hours period

• Postoperative pain scores (NRS-Numerical Rating Scala)

  Changes from baseline pain scores at postoperative 1, 4, 8, 16 and 24 hours

• The incidence of adverse events

  Postoperative 24 hours period

Study Arms (2)

Group QLB = QLB group

ACTIVE COMPARATOR

Posterior QLB will be performed

Other: QLB; Other: Postoperative analgesia management

Group ESPB = ESPB Group

ACTIVE COMPARATOR

Lumbar ESPB will be performed

Other: ESPB; Other: Postoperative analgesia management

Interventions

QLB OTHER

The block procedure will be applied after the surgery and before extubation with patients in the prone position by using US (Vivid Q, GE Healthcare, US). Under aseptic conditions, the convex probe will be covered with a sterile sheath and a 22G, 80 mm block needle (Braun Stimuplex Ultra 360, Germany) will be used. After visualizing the quadratus lumborum muscle, the needle will be punctured and 5 ml of saline will be injected into the posterior border of the quadratus lumborum muscle between QLM and latissimus dorsi muscle.. After the block location is confirmed, 30 ml of 0.25% bupivacaine will be injected. The same process will be applied to the opposite side (60 ml totally).

Group QLB = QLB group

ESPB OTHER

ESP block will be performed. Convex probe will be placed longitudinally 4 cm lateral to the L3 transverse process. Erector spinae muscle will be visualized on the hyperechoic transverse process. The block needle will be inserted cranio caudal direction and then for correction of the needle, 2 ml saline will be injected deep into the erector spina muscle fascia. Following confirmation of the correct position of the needle 30 ml %0.25 bupivacaine will be administered for the block in each side (total 60 mL).

Group ESPB = ESPB Group

Postoperative analgesia management OTHER

Patients will be administered paracetamol 1 gr IV every 8 hours in the postoperative period. Postoperative patient evaluation will be performed by a pain nurse blinded to the procedure. Tramodol will be performed for rescue analgesia.

Group ESPB = ESPB Group; Group QLB = QLB group

Eligibility Criteria

• Age: 18 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• American Society of Anesthesiologists (ASA) classification I-II
• Scheduled for lumbar disc herniation-laminectomy surgery under general anesthesia

You may not qualify if:

• history of bleeding diathesis,
• receiving anticoagulant treatment,
• known local anesthetics and opioid allergy,
• infection of the skin at the site of the needle puncture,
• pregnancy or lactation,
• patients who do not accept the procedure
• Change in surgical technique in the intraoperative period

Sponsors & Collaborators

• Medipol University: lead

Study Sites (1)

Istanbul Medipol University Hospital

Istanbul, Bagcilar, 34070, Turkey (Türkiye)

Location

Related Publications (5)

• Oh SK, Lim BG, Won YJ, Lee DK, Kim SS. Analgesic efficacy of erector spinae plane block in lumbar spine surgery: A systematic review and meta-analysis. J Clin Anesth. 2022 Jun;78:110647. doi: 10.1016/j.jclinane.2022.110647. Epub 2022 Jan 11.

  PMID: 35030493 BACKGROUND

• Qiu Y, Zhang TJ, Hua Z. Erector Spinae Plane Block for Lumbar Spinal Surgery: A Systematic Review. J Pain Res. 2020 Jul 1;13:1611-1619. doi: 10.2147/JPR.S256205. eCollection 2020.

  PMID: 32669870 BACKGROUND

• Tulgar S, Aydin ME, Ahiskalioglu A, De Cassai A, Gurkan Y. Anesthetic Techniques: Focus on Lumbar Erector Spinae Plane Block. Local Reg Anesth. 2020 Sep 25;13:121-133. doi: 10.2147/LRA.S233274. eCollection 2020.

  PMID: 33061562 BACKGROUND

• Canikli Adiguzel S, Akyurt D, Bahadir Altun H, Ultan Ozgen G, Akdeniz S, Bayraktar B, Tulgar S, Yigit Y. Posterior Quadratus Lumborum Block or Thoracolumbar Interfascial Plane Block and Postoperative Analgesia after Spinal Surgery: A Randomized Controlled Trial. J Clin Med. 2023 Nov 21;12(23):7217. doi: 10.3390/jcm12237217.

  PMID: 38068268 BACKGROUND

• Alver S, Ciftci B, Celik EC, Sargolzaeimoghaddam M, Cetinkal A, Erdogan C, Ahiskalioglu A. Postoperative recovery scores and pain management: a comparison of modified thoracolumbar interfascial plane block and quadratus lumborum block for lumbar disc herniation. Eur Spine J. 2024 Jan;33(1):118-125. doi: 10.1007/s00586-023-07812-3. Epub 2023 Jun 14.

  PMID: 37314577 BACKGROUND

MeSH Terms

Conditions

Intervertebral Disc Displacement

Condition Hierarchy (Ancestors)

Spinal Diseases; Bone Diseases; Musculoskeletal Diseases; Hernia; Pathological Conditions, Anatomical; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: Outcomes Assessor and participant were blinded to the study
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: Sixty patients aged 18-65 years old with American Society of Anesthesiologists (ASA) classification I-II and scheduled for lumbar disc herniation surgery will be included in the study. Patients will be randomly divided into two groups (Group QLB = QLB group, Group ESPB = ESPB group) including 30 patients each, before entering the operating room.

Study Record Dates

• First Submitted: June 13, 2024
• First Posted: June 27, 2024
• Study Start: August 6, 2024
• Primary Completion: February 20, 2025
• Study Completion: February 22, 2025
• Last Updated: August 8, 2025

Record last verified: 2025-08

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)