Acute postoperative pain is an important issue after major abdominal surgeries for which different analgesic modalities have been tried. Epidural analgesia is the recommended technique to relieve pain after major abdominal surgeries owing to the proved superior analgesia, reduction of opioid-related side effects as nausea, vomiting, pruritis and sedation, earlier recovery of bowel function and earlier ability for postoperative mobility. However, it is not without complications. Quadratus lumborum block is an ultrasound-guided block that provides patients with both visceral and somatic blockade. It lessens the potential risks associated with neuraxial techniques, so it may represent a novel alternative approach for analgesia after major abdominal surgeries.
The aim of this study is to detect the feasibility of ultra-sound guided bilateral quadratus lumborum block as a postoperative analgesic modality after major abdominal surgery in comparison to epidural block and its effects on total rescue analgesic requirements in the 1st postoperative 24hours, time to first analgesic request, pain VAS scores, intraoperative and postoperative hemodynamics and postoperative opioid-related side effects. Under complete aseptic conditions, the patients will receive either thoracic epidural block or bilateral ultrasound-guided quadratus lumborum block after induction of general anaesthesia
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
80
Patients who will be subjected to epidural block will be placed in the lateral position then, after sterilization of the skin, 21 G spinal needle will be inserted at T9-T11 intervertebral spaces. The epidural space will be located using the loss of resistance to air technique and a mixture of bupivacaine 0.25% + 50 μ fentanyl targeting T6 level will be injected following induction of general anaesthesia.
Patients who will be subjected to major abdominal surgeries will be placed in a supine position with a pillow under their side to obtain an appropriate view of quadratus lumborum muscle. After sterilization of the skin and ultrasound-guided identification of the quadratus lumborum muscle, 20 ml bupivacaine 0.25% + 25μ fentanyl will be injected on each side following induction of general anaesthesia
propofol: 1.5-2.5mg/Kg
Atracurium : 0.5mg/Kg.
Sevoflurane 0.7-1.5 MAC in 40% oxygen
Mohammed A Ghanem
Al Mansurah, DK, Egypt
Postoperative 24 hours cumulative rescue morphine consumption
Time frame: For 24 hours after surgery
The duration of postoperative analgesia
time from performing epidural or quadratus lumborum block till the time for the first rescue morphine request
Time frame: For 24 hours after surgery
Postoperative pain score at rest
Visual analogue scale to assess the severity of postoperative pain (0 mm for no pain and100 mm for worst imaginable pain)
Time frame: For 24 hours after surgery
Postoperative pain score on movement
Visual analogue scale to assess the severity of postoperative pain (0 mm for no pain and100 mm for worst imaginable pain)
Time frame: For 24 hours after surgery
Postoperative pain score on cough
Visual analogue scale to assess the severity of postoperative pain (0 mm for no pain and100 mm for worst imaginable pain)
Time frame: For 24 hours after surgery
Systolic blood pressure
Time frame: For 28 hours after induction of anesthesia
Diastolic blood pressure
Time frame: For 28 hours after induction of anesthesia
Mean blood pressure
Time frame: For 28 hours after induction of anesthesia
Heart rate
Time frame: For 28 hours after induction of anesthesia
Degree of postoperative nausea and vomiting
Nausea will be measured using a numerical rating system (none= 0; mild= 1; moderate= 2; severe= 3). The number of vomiting episodes and the number of antiemetics received will be recorded
Time frame: For 24 hours after surgery
Pruritis
Time frame: For 24 hours after surgery
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