Cancer Clinical Trial
Official title:
Analgesia for Laparotomy in Cancer Patients:Ultrasound-guided Quadratus Lumborum Block Versus Transversus Abdominis Plane Block
Regional anesthesia of the abdomen significantly reduce postoperative pain, spare the
systemic opioids and decrease postoperative nausea and vomiting. Multiple regional techniques
can be performed at the neuro-axis (epidural), the nerve root (paravertebral) and the
peripheral nerve (transversus abdominis plane).
Quadratus lumborum (QL) block is an addition into the league of truncal nerve block
techniques that has been found to provide analgesia for abdominal surgeries. Several case
reports have shown that local anesthetic injection around the quadratus lumborum muscle is
effective in providing pain relief after various abdominal operations and in patients with
chronic pain.
The study hypothesis is that quadratus lumborum block in single shot may be more superior to
transversus abdominus plane block as regard intra-operative and the post-operative analgesia.
This is a prospective randomized controlled study conducted at Oncology Center-Mansoura
University.
102 patients were randomly allocated by closed envelope method into 2 equal groups:
- Quadratus lumborum block Group (Q) (n= 51): patients received 15 ml of 0.5% isobaric
bupivacaine + 10 ml saline + 50 ug dexmedetomidine + epinephrine (1:100,000) for each
side.
- Transversus abdominis plane Group (T) (n= 51): patients received 15 ml of 0.5% isobaric
bupivacaine + 10 ml of saline + 50 ug dexmedetomidine + epinephrine (1:100,000) for each
side.
All blocks were performed after induction of general anesthesia and approximately 15 min
before the skin incision.
- Technique of ultrasound guided quadratus lumborum Block: patient lie in lateral position
to obtain appropriate view of quadratus lumborum and transversus abdominins plane
extension of lateral abdominal muscles. In this approach, a high-frequency linear
transducer (7-12 MHZ) attached to ultrasound machine was placed in anterior axillary
line to visualize the typical triple abdominal layers. At the junction of the tapered
ends of abdominal muscles and quadratus lumborum, a 21 G cannula needle was inserted in
plane and confirmed its position by injecting saline. Under ultrasound guidance, saline
separating thoracolumbar fascia from muscle is observed then local anesthetic is
injected.
- Technique of ultrasound guided Transversus abdominis plane Block: Patient lie in supine
position and high-frequency linear transducer (7-12 MHZ) attached to ultrasound machine
placed in anterior axillary line between costal margin and iliac crest to visualize the
typical triple abdominal layers. A 21 G cannula needle is then moved forward from an
anteromedial position in a posterior and lateral direction using an in-plane technique
with the entry point in the skin being separated from the probe in order to improve
needle visibility in the long axis. The needle tip is inserted between transversus
abdominis muscle and internal oblique muscle then local anesthetic is injected to
produce separation between the two muscle.
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