1. Transmuscular quadratus lumborum block versus thoracic paravertebral block for acute pain and quality of recovery after laparoscopic renal surgery: study protocol for a randomized controlled trial
- Author
-
Xu Zhonghuang, Qing Yuan, Yuguang Huang, Yuda Fei, and Cui Xulei
- Subjects
Laparoscopic surgery ,Adult ,Adolescent ,Nausea ,Visual analogue scale ,medicine.medical_treatment ,Analgesic ,Medicine (miscellaneous) ,Nephrectomy ,law.invention ,03 medical and health sciences ,Young Adult ,Study Protocol ,0302 clinical medicine ,Randomized controlled trial ,law ,Outcome Assessment, Health Care ,medicine ,Humans ,Pharmacology (medical) ,Paravertebral Block ,030212 general & internal medicine ,Prospective Studies ,Abdominal Muscles ,Aged ,Data Management ,Randomized Controlled Trials as Topic ,Aged, 80 and over ,lcsh:R5-920 ,Pain, Postoperative ,Ropivacaine ,business.industry ,Thoracic paravertebral block ,Nerve Block ,Middle Aged ,Acute Pain ,Quadratus lumborum block ,Anesthesia ,Laparoscopy ,medicine.symptom ,lcsh:Medicine (General) ,business ,Enhanced Recovery After Surgery ,030217 neurology & neurosurgery ,medicine.drug ,Abdominal surgery - Abstract
Background Quadratus lumborum block (QLB) is increasingly gaining popularity as a novel abdominal truncal block in abdominal surgery; however, the mechanism of QLB is not yet thoroughly illustrated. The focus of our study is transmuscular QLB (TMQLB), as the latest anatomical evidence shows that anesthetics spread into the thoracic paravertebral space to exert an analgesic effect. Therefore, we designed this study to compare TMQLB with thoracic paravertebral block (TPVB) in laparoscopic renal surgery in the hope of providing clinical evidence on the analgesic mechanism of TMQLB and its application in laparoscopic renal surgery. Methods This trial is a prospective, randomized, single-center, open-label, parallel, three-arm, non-inferiority trial. We intend to include 120 participants undergoing laparoscopic nephrectomy and before surgery they will be randomized into three groups for postoperative pain control: TMQLB experimental group 1 (0.4 ml/kg body weight 0.5% ropivacaine), TMQLB experimental group 2 (0.6 ml/kg body weight 0.5% ropivacaine) or TPVB control group (0.4 ml/kg body weight 0.5% ropivacaine at vertebra T10). Patients will be excluded if they have allergy to anesthetics, infection at the injection site, are on coagulopathy or anticoagulants, on analgesics for chronic illness, have history of substance abuse or have a barrier to communication. Morphine is given in boluses of 1.5~2 mg by intravenous patient-controlled analgesia (IPCA) in the first 48 h after surgery. The primary outcome is the difference between TMQLB group 1 and the TPVB group in the mean visual analogue scale (VAS) pain score in the first 24 h after surgery. Secondary outcomes are the difference between TMQLB group 2 and the TPVB group in the mean VAS score in the first 24 h after surgery, cumulative morphine consumption, long-term pain control, dermatomal distribution of sensory loss, nausea score, pruritus score, ambulation time, time till recovery of bowel movement, quality of recovery, postoperative length of hospital stay and patient satisfaction with anesthesia. Safety data on procedure-related complications will also be summarized. Discussion This will the first randomized controlled trial to compare TMQLB with TPVB for analgesia in laparoscopic surgery. This trial aims to provide important clinical evidence to elaborate on the analgesic mechanism of TMQLB. Trial registration ClinicalTrials.gov, NCT03414281. Registered on 9 January 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3359-7) contains supplementary material, which is available to authorized users.
- Published
- 2018