Quadratus Lumborum Block for Percutaneous Nephrostomy

Phase 4WithdrawnNCT02121951

National Cancer Institute, Egypt

Overview

Percutaneous nephrostomy (PCN) is one of the interventions in the radiology department in which pain control is necessary. Quadratus Lumborum (QL) block will be tried to limit the use of systemic analgesics and its accompanying untoward effects in those frail patients requiring PCN that is performed in the prone position.

Quadratus Lumborum block is a novel technique in which extension into the thoracic paravertebral space may occur. QL block would seem to be able to alleviate both somatic and visceral pain so it's expected to decrease the need for systemic sedation\\analgesia to a minimum.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Conditions

Nephrostomy; Complications Upper Urinary Tract Dilatation and Obstruction Regional Anesthesia Morbidity Adverse Anesthesia Outcome

Interventions

Local Anesthetic infiltrationPROCEDURE

Lignocaine infiltration through the nephrostomy track

Quadratus Lumborum blockPROCEDURE

A linear 12-MHz ultrasound probe will be placed in the anterior axillary line to visualize the typical triple abdominal layers. Then, the probe will be placed in the midaxillary line and at this point the layers of abdominal layers starte to taper. The probe will be placed in the posterior axillary line, sonoanatomy will show first the transversus abdominis disappearing then the internal oblique and external oblique forming aponeurosis and appearance of QL will be noticed. At the posterior border of the quadratus lumborum muscle and outside the fascia, Touhe needle will be inserted in plane and confirmed its position by injecting saline. Under ultrasound (US) guidance, local anesthetic mixure will be deposited separating the fascia

MAC

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. ASA grade III and IV patients, 2. Ureteral obstruction due to malignancy or secondary to urinary diversion after cystectomy Exclusion Criteria: 1. Bleeding diathesis; INR more than than 1.5 and platelet count less than 100,000/mm3. 2. Untreated urinary tract infection; 3. Pre-operative haemoglobin \<10 gm/dl, 4. Severely co morbid patients 5. Non-dilated renal collecting system 6. Patient refusal to consent for the procedure.

Locations (1)

National Cancer Institute

Cairo, Old Cairo, Egypt

Outcomes

Primary Outcomes

Analgesia

Verbal Rating Scale is assessed for degree of pain during the procedure and after till discharge from the radiology department.

Time frame: 4 hours

Secondary Outcomes

Respiratory Depression

Respiratory rate and airway patency is monitored with an anesthesiologist.

Time frame: 4 hours

Sedation

Ramsay Seadation Score is assessed during and after procedure till discharge

Time frame: 4 hours

Cardiovascular stability

Blood pressure and Heart rate is assessed during and after procedure till discharge

Time frame: 4 hours

Patient Satisfaction

Patient Satisfaction Quistionaire

Time frame: 48 hours

Data from ClinicalTrials.gov

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