A Trial Comparing Quadratus Lumborum Block (QLB) and Paravertebral Block (PVTB) for Postoperative Analgesia in Hepatectomy

Nanfang Hospital, Southern Medical University180 enrolled

Overview

Pain after hepatectomy can interfere with the patients' recovery and may contribute to developing long term pain. Opioids, e.g. morphine, fentanyl, sufentanil, works well for postoperative analgesia, but have several side effects such as nausea, vomiting and itching which may be severe enough to affect patients' recovery. In some cases, opioids may cause constipation and urinary retention within the first 24 hours after surgery. Thus, several ultrasound-guided nerve block procedures have been applied to provide postoperative analgesia. Ultrasound-guided thoracic paravertebral block (TPVB) is one of the most used nerve block methods using for post-hepatectomy analgesia. However, in some cases, ultrasound-guided TPVB can cause pneumothorax, hemopneumothorax, and higher block level. The quadratus lumborum block (QLB) is a new developed nerve block which can provide a widespread analgesic effect from T7 to L1. Therefore, this study is to determine whether QLB or TPVB have a better pain control with fewer side effects and complications after laparoscopic and open hepatectomy. The adequate pain control will be assessed by their visual analogue score (VAS) and the postoperative quality of recovery scale (QoR-15, Chinese Version). Additionally, the side effect and complications profile of these two nerve block techniques will also be recorded and compared.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

DOUBLE

Enrollment

180

Conditions

Quadratus Lumborum Block

Interventions

Patient-controlled intravenous analgesiaOTHER

PCIA solution: 2 μg/kg weight sufentanil and 8.96 mg tropisetron mesylate diluted in 100 ml normal saline；PCIA parameters: loading dose: 2 ml, background infusion: 2ml/h, bolus: 0.5ml, lockout-time: 15min; PCA duration: 48 hours from the end of suturing

Quadratus Lumborum BlockOTHER

Ultrasound-guided Quadratus lumborum block: A broadband (5-8 MHz) convex transducer will be placed transversely in the abdominal flank above the iliac crest to identify the external oblique, internal oblique, transversus abdominis muscles and aponeurosis. Then the external oblique muscle will be followed posteriorly until its posterior border is visualized (hook sign), and the posterior aspect of the Quadratus lumborum muscle is confirmed. A 22-G, 11-mm, short-bevel facet needle will be advanced under direct ultrasound visualization in-plane from anterolateral to postero-medial. Then the 20 ml of 0.375 % ropivacaine will be injected into the lumbar inter-facial triangle (LIFT) behind the quadratus lumborum muscle using hydro-dissection.

Thoracic Paravertebral BlockOTHER

Ultrasound-guided Thoracic paravertebral block: The patient is placed in the lateral position, the spinous processes of T6 and T8 are identified and marks are made 2cm lateral to the spinous processes. The linear(L12-3) probe is placed transversally at the mark to identify the paravertebral space. Then a 22-G needle is inserted in-plane from lateral to medial and advanced until the tip reached the paravertebral space surrounded by the parietal pleura and the superior costotransverse ligament. Then 15 ml 0.375% ropivacaine is injected into the paravertebral space of T6 and T8.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients aged between 18 and 65 years old for selective hepatectomy from nanfang Hospital, Southern Medical University * American Society of Anesthesiologists (ASA) risk class I-III; * Body Mass Index (BMI) is not lesser than 18 and not greater than 30; Exclusion Criteria: * Patients refuse to participate * Allergy to the any agents used in current clinical trial; * Dependence, tolerance or excessive sensitivity to the anesthetics and psychotropic drugs; * Patients with nerve block contraindications (e.g. local infection of skin or soft tissue in injection site, serious bleeding tendency or hemorrhagic disease, anatomical aberration which make anesthesiologist cannot perform the ultrasound-guided nerve block, allergic history of local anesthetics, etc.); * Previous abdominal surgery (except for diagnostic biopsy); * New York Heart Association (NYHA) classification of cardiac function grade IV and/or Ejection Fraction (EF)≤55%; * Child-Pugh grading * Liver function of grade C (Child-Pugh grading) * Glomerular filtration rate≤60ml/min/1.73m2; * Obstructive sleep apnea syndrome; * Chronic obstructive pulmonary disease, asthma, active tuberculosis; * Cardiac rhythm disorders; * Past or present history of nervous system diseases and mental disorders (such as epilepsy, Alzheimer's disease, Parkinsonism syndrome, depression,etc.); * Autoimmune diseases (such as lupus erythematosus, rheumatoid arthritis,etc.) * Malignant tumors of other systems; * Other operations are required during the same period;

Outcomes

Primary Outcomes

VAS

The visual analogue scale (VAS) is a psychometric response scale which can be used in questionnaires. It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured. When responding to a VAS item, respondents specify their level of agreement to a statement by indicating a position along a continuous line between two end-points. In current study visual analogue scale is be adopt to assess pain of patients. The VAS ranges from 0-10,0 represents no pain and 10 represents the worst pain.

Time frame: From 1 day before the surgery to the 2 days after surgery

QoR-15/Quality of Recovery Scale 15(QoR-15)

The Quality of Recovery-15 scale (QoR-15) is an easy-to-use score for assessing the quality of post-operative recovery. The QoR-15 is a 15-item questionnaire intended to measure QoR after anesthesia and surgery. It comprises five subscales: pain (n = 2), physical comfort (n = 5), physical independence (n = 2), psychological support (n = 2), and emotional state (n = 4) . Each item is scored from 0 to 10, and the possible total score ranges from 0 to 150. A higher total score means better patient QoR.

Time frame: From 1 day before the surgery to the 2 days after surgery

Secondary Outcomes

Total opioids consumption

The total amount of opioids consumed during perioperative period

Time frame: From admitting in operation room to 48 hours after hepatectomy

Opioids consumption during hepatectomy Intraoperative opioids consumption

Total doses of opioids consumed during the surgical procedure intraoperatively

Time frame: At the end of surgical procedure

Opioids consumption after hepatectomy

Opioids consumption after hepatectomy which are administrated by Patient-controlled intravenous analgesia(PCIA) and by physician's order