Rhomboid Intercostal and Subserratus Plane Block Versus Quadratus Lumborum Block in Management of Postoperative Pain After Open Nephrectomy

NCT06983249 | Active Not Recruiting DMC

• 1 other identifier: MD186/2024
• Study Type: interventional
• Target: 50
• Locations: 1 country
• Sites: 1

Brief Summary

Rhomboid intercostal block (RIB) and Rhomboid intercostal block with sub-serratus plane block (RISS) are the two types of plane blocks used for postoperative analgesia after abdominal surgeries. For achieving proper postoperative analgesia, multimodal regimens have been described for patients undergoing abdominal procedures like cholecystectomy. These multimodal regimens could include opioid medications, non-opioid analgesics (e.g., acetaminophen and ketorolac), and regional blocks. These modalities could be used alone or in combination. This prospective randomised controlled trial was performed to analyse the postoperative analgesic effects of ultrasound guided Quadratus lumborum block and RISS block in managing post operative pain in patients undergoing open nephrectomy.

Conditions

Open Nephrectomy Surgery

Keywords

Rhomboid intercostal subserratus

Outcome Measures

Primary Outcomes (1)

• Primary outcome

  Primary outcome: Time of first post operative analgesic demand

  One year

Secondary Outcomes (1)

• Secondary outcome

  One year

Study Arms (2)

Quadratus lumborum nerve block in nephrectomy

EXPERIMENTAL

Qudaratus lumborum nerve block ultrasound guided in nephrectomy

Procedure: Quadratus lumborum nerve block in nephrectomy

Rhomboid intercostal and Sub-serratus nerve block in nephrectomy

EXPERIMENTAL

Rhomboid intercostal and subserratus nerve block ultrasound guided

Procedure: Rhomboid intercostal and Sub-serratus nerve block in nephrectomy

Interventions

Rhomboid intercostal and Sub-serratus nerve block in nephrectomy PROCEDURE

That block was performed when the patient was in the lateral position. A high frequency linear ultrasound transducer was placed longitudinally on the patient's back, just 2 cm medial to the medial scapular border. Then, the probe was slightly rotated to obtain an oblique parasagittal plane. The following landmarks were identified: the trapezius muscle, rhomboid major muscle, intercostal muscles, pleura, and lungs (from superficial to deep in order of appearance). Under ultrasound guidance, a 22 mm gauge spinal needle was directed to the plane by using high frequency ultrasound guidence (Sono SiteTM, Inc., Bothell, WA 98021, USA) between the rhomboid major and the underlying intercostal muscles and 15 ml bupivacaine (0.25%) was delivered into that plane (after repeated negative aspiration of blood), and its spread was manifested by the hydrodissection and widening of the plane visualized by ultrasound

Also known as: Rhomboid intercostal and subserratus nerve block

Rhomboid intercostal and Sub-serratus nerve block in nephrectomy

Quadratus lumborum nerve block in nephrectomy PROCEDURE

Ultrasound guided posterior quadrates lumborum block was done in lateral decubitus position and linear probe according to the depth was placed in the midaxillary line in the transverse plane immediately above the iliac crest and then it was slided dorsally until the "Shamrock sign" was clearly identified. In "Shamrock sign" The quadratus lumborum (QL) muscle is seen as a superior leaf of the Shamrock at the apex of the transverse process (TP) of L4

Also known as: QLB

Quadratus lumborum nerve block in nephrectomy

Eligibility Criteria

• Age: 40 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients undergoing open nephrectomy.
• ASA physical status II, III
• Sex (males and females)
• Age 40-70 years

You may not qualify if:

• Patient refusal or with difficulties in comprehending visual analogue scale (VAS) pain scores
• Any contraindications for regional anesthesia. (eg: coagulopathy, use of anticoagulants or antiplatelets...)
• Hypersensitivity to local anesthetics.
• Infection near site of injection.

Sponsors & Collaborators

• Ain Shams University: lead

Study Sites (1)

Ainshams university

Cairo, Cairo Governorate, Egypt

Location

Related Publications (3)

• Elsharkawy H, Hamadnalla H, Altinpulluk EY, Gabriel RA. Rhomboid intercostal and subserratus plane block -a case series. Korean J Anesthesiol. 2020 Dec;73(6):550-556. doi: 10.4097/kja.19479. Epub 2020 Feb 12.

  PMID: 32046475 BACKGROUND

• West D. Evaluation of rhomboid intercostal and subserratus plane block under direct vision for postoperative analgesia in thoracic surgeries: a prospective, randomized controlled trial, thoracic non-oncologic. Eur J Cardiothorac Surg. 2022 Nov 3;62(6):ezac532. doi: 10.1093/ejcts/ezac532. No abstract available.

  PMID: 36367247 BACKGROUND

• Kozanhan B, Semerkant T, Esme H, Canitez A, Iyisoy MS. Evaluation of rhomboid intercostal and subserratus plane block under direct vision for postoperative analgesia in thoracic surgeries: a prospective, randomized controlled trial. Eur J Cardiothorac Surg. 2022 Nov 3;62(6):ezac498. doi: 10.1093/ejcts/ezac498.

  PMID: 36218395 BACKGROUND

MeSH Terms

Interventions

Nephrectomy

Intervention Hierarchy (Ancestors)

Urologic Surgical Procedures; Urogenital Surgical Procedures; Surgical Procedures, Operative

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: The eligible patients will be enrolled in this double blinded study and randomly allocated into one of two parrallel equal groups (25 patients in each group) according to sample size by computer generated random number litst. The allocation will be concealed, the data will blind to the study group. Two persons should be blinded; the patient and the investigator who will monitor the patients
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: The eligible patients will be enrolled in this double blinded study and randomly allocated into one of two parrallel equal groups (25 patients in each group) according to sample size by computer generated random number list. The allocation will be concealed, the data will blind to the study group. Two persons should be blinded; the patient and the investigator who will monitor the patients. Groups: Patients will be assigned randomly into two equal groups: Group (A): patients will receive RISS block under ultrasound guide 30 ml bupivacaine 0.25%. Group B "Quadratus lumborum block": patients will Receive ultra sound guided Quadratus Lumborum block using 20 ml Bupivacaine 0.25% on operated side.

Study Record Dates

• First Submitted: November 28, 2024
• First Posted: May 21, 2025
• Study Start: July 1, 2025
• Primary Completion (Estimated): September 1, 2026
• Study Completion (Estimated): September 1, 2026
• Last Updated: September 11, 2025

Record last verified: 2024-09

Data Sharing

• IPD Sharing: Will not share

Locations

EG (1)