Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT04259645 |
| Other study ID # |
STUDY19090192 |
| Secondary ID |
|
| Status |
Completed |
| Phase |
Phase 4
|
| First received |
|
| Last updated |
|
| Start date |
April 1, 2021 |
| Est. completion date |
January 30, 2023 |
Study information
| Verified date |
January 2023 |
| Source |
University of Pittsburgh |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Interventional
|
Clinical Trial Summary
There is Controversy about what is more critical volume or concentration to achieve an
optimum analgesic treatment with quadratus lumborum block. From the experiences of the
authors, the regular dose of 20 ml of Bupivacaine at 0.375% concentration could not be enough
in some cases to produce an optimum analgesic treatment, especially in hip arthroplasties.
What is proposed in this study is to evaluate whether the volume injected in the quadratus
lumborum block is more important than the concentration of the local anesthetic in terms of
control of pain during the next 24 hours after surgery and opioid consumption.
Description:
The Quadratus Lumborum Block (QLB) was originally described by Blanco in 2007 as a posterior
variation of the Transversus Abdominis Plane block. It is now, however, recognized as a
unique, alternative, and separate interfascial plane block. The QLB has been studied and
compared with other types of blocks and it may offer several advantages such as simplicity,
safety, and avoidance of hypotension. Additionally, dermatomal coverage may be greater than
for other types of blocks. In cadaveric studies the paravertebral spread of dye was found
from T7-L5 , although an vivo study in healthy volunteers showed the paravertebral spread of
the contrast solution only between T10-L1 at 1 hour after the block. It is noted that while
these anatomical studies invariably show the spread of contrast or dye extending to the
paravertebral space that spread may be limited in degree. Thus follows a point of significant
controversy as to whether the paravertebral space is in fact the block's primary site of
action or whether it acts primarily on nerves, radicular and sympathetic, situated in the
thoracolumbar fascia. Questions of mechanism and site of action notwithstanding, the safety
and clinical efficacy of this block has been clearly demonstrated in multiple types of
surgeries including abdominal laparoscopic , open laparotomy , urologic , and general surgery
with analgesia lasting roughly 24 hours, decreased consumption of opioids, decreased time to
ambulation, and decreased hospital length of stay. In recent studies, QL block employment was
shown to produce a significant reduction in length of stay during hip surgery as well as
similar analgesia to Lumbar Plexus blockade.
The quadratus lumborum block has since 2016 become standard of care for abdominal and hip
surgeries at our institution, replacing paravertebral and lumbar plexus blocks respectively,
and as part of a broader multimodal analgesia institutional ERAS (Enhanced Recovery After
Surgery) protocol. Coincident with its implementation we have seen significant reductions in
opiate and PCA use as well as hospital length of stay. Similar results have been reported by
other institutions.
Since the first description of this technique, several approaches to and anatomic targets
within the quadratus lumborum plane have been described although their mechanism of action,
spread, and relative clinical effectiveness remain areas of some debate. There remain many
unanswered questions regarding this block and its subtypes. It is, for example, unknown if
one technique would be better than another for different types of surgery. Likewise little is
known of the relative importance of local anesthetic concentration and injectate volume - the
principal question addressed by this proposed study.
