This study aims to assess if Quadratus Lumborum (QL) blocks are non-inferior to epidural analgesia for pain control and opioid consumption through the third postoperative day in patients having open partial nephrectomy. Patients satisfying all inclusion and exclusion criteria will be randomized in a 1:1 ratio to either epidural catheter or QL catheter.
QL blocks with a single shot and catheters infusions may be an alternative to epidural analgesia. However, the relative efficacy, safety, and cost of the two approaches remain unclear. Epidural analgesia is frequently used as a component of multimodal analgesia for thoracic and abdominal surgery. QL block has been introduced recently as a component of multimodal analgesia for lower thoracic and abdominal surgery. In general, insertion of QL catheter is easier and safer than insertion of epidural catheters. QL catheter management is also less complicated than epidural analgesia (fewer catheter displacements and less hemodynamic compromise) and decreases the level of complexity in postoperative care. Our hypothesis is that the subcostal QL approach with a continuous catheter is non-inferior to epidural analgesia for pain control and opioid consumption in patients having open partial nephrectomy procedure.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
DOUBLE
Enrollment
57
Quadratus lumborum (QL) block for open partial nephrectomy.
Epidural analgesia for open partial nephrectomy.
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Total opioid consumption
Total IV morphine-equivalent doses used, started postoperatively at the time of arrival to post anesthesia care unit until 72 hours after surgery.
Time frame: Arrival to post anesthesia care unit until 72 hours after surgery
Postoperative pain
Time-weighted average verbal rating scale for pain until 72 hours after operation as a time-weighted average, based on nursing assessments at four-hour intervals. The verbal rating scale ranges from 0 to 10, with 0 indicating no pain and 10 indicating worst pain imaginable. Time-weighted average pain is defined as the sum of each time interval between two adjacent pain score measurements multiplied by the average of the two corresponding pain scores divided by the time interval between the first and last pain scores.
Time frame: Arrival to post anesthesia care unit until 72 hours after surgery
Patient Global Assessment
Patient global assessment of pain control is measured on an ordinal scale by the patient. Patients can rate their pain control as poor, fair, good, or excellent.
Time frame: Three days after surgery
Doses of antiemetic medications administered
Count of the number of antiemetic medications administered.
Time frame: Arrival to post anesthesia care unit until the third day after surgery
Duration of postoperative hospitalization
Duration of postoperative hospitalization
Time frame: From the date of surgery to hospital discharge, assessed up to 12 months.
Episodes of hypotension
Number of episodes of hypotension during hospital stay, defined by MAP less than 65 mmHg requiring intervention.
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Time frame: Arrival to post anesthesia care unit until the third day after surgery