Comaprison Between QLB and ESPB in Patients for PCNL Operation

Assiut University92 enrolled

Overview

comparing the subcostal oblique Quadratus Lumborum block and the Erector Spinae plane block in patients undergoing percutaneous nephrolithotomy operation to get the best and longest postoperative analgesic effect.

Here the investigators are going to compare between the Anterior approach for the subcostal oblique Quadratus Lumborum block (QLB) and the Erector Spinae Plane Block (ESPB) to determine their level of spread and their value in controlling postoperative pain in patients scheduled for Percutaneous Nephrolithotomy surgery. We hypothesized that quadratus lumborum is not inferior regarding the duration of analgesia when compared to erector spinae in patients undergoing percutaneous nephrolithotomy under general anesthesia.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

QUADRUPLE

Enrollment

Conditions

Pain, Postoperative

Interventions

Subcostal Oblique Quadratus Lumborum Block and Erector Spinae Plain Block.PROCEDURE

patients undergo general anesthesia,will be put in prone position.In case of Quadratus Lumborum block 1-3 mL of normal saline is injected to produce hydro-dissection and spread cranially between the QL and kidney. The corresponding ultrasonographic sign is a lunar-shaped hypo-echoic fluid collection observed between the long axis of the kidney and QL muscle. 20 ml Bupivacaine 0.5%, 10 ml Lidocaine 2%, and 10 ml normal saline is administered. In case of the ESPB The location of the needle tip is confirmed by hydro-dissection and after visualizing the fluid spread lifting the Erector Spinae off the transverse process, 20 ml bupivacaine 0.5%, 10 ml Lidocaine 2%, and 10 ml normal saline is injected.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 60 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Both sex * Age: 18-60 * ASA (American Society of Anesthesiologists) class I and II * Elective surgery * Patients undergoing PNL surgery Exclusion Criteria: * Patient's refusal * Allergy or contraindications to drugs used in the study * Emergency surgery * Psychiatric disorders * Severely co-morbid patients * Inflammation or infection over injection site * Bleeding diathesis; INR more than 1.5 and Platelet count less than 100,000/mm3 * Peripheral neuropathy * Obese patients BMI ≥35 * Patients on previous opioid therapy * Pre-operative haemoglobin \<10 mg/dl * Inability to properly describe postoperative pain to investigators * Coagulation abnormalities * History of drug addiction or alcohol abuse * History of Previous renal surgery

Locations (1)

Assiut University Hospitals

Asyut, Egypt

Outcomes

Primary Outcomes

Analgesia

Total opioid consumption during the first 48hours postoperatively.

Time frame: 48 hours

Secondary Outcomes

Analgesia

first Analgesic request postoperatively.

Time frame: 24 hours

episodes of nausea and vomiting

to investigate if there is or not.

Time frame: within 24 hours postoperative

Pain Scores using Visual Analog Scale (VAS) Scores

VAS is a scale to determine the patient's pain level.

Time frame: 24 hours postoperative.

ambulation time

time from the end of the surgery to the first time to out-of-bed activity

Time frame: 5 days postoperative

time of recovery of bowl movement

time from the end of the surgery to the first time of bowl movement

Time frame: 5 days postoperative

patient satisfaction with anesthesia

Patient satisfaction with anesthesia was assessed using a 5-point scale (5: very satisfied; 4: satisfied; 3: neither satisfied nor dissatisfied; 2: dissatisfied; 1: very dissatisfied)

Time frame: 48 hours postoperative.

postoperative length of hospital stay

till time of discharge

Time frame: within 2 weeks postoperative.

Data from ClinicalTrials.gov

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