Effect of Quadratus Lumborum Block With Compound Lidocaine and Esketamine on Pain After Colorectal Surgery

Postoperative Pain Clinical Trial

Official title:

Effect of Ultrasound-guided Quadratus Lumborum Block With Compound Lidocaine and Esketamine on Postoperative Pain in Patients Undergoing Colorectal Surgery: a Randomized Double-blind Controlled Trial

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT05964985
• Other study ID #: GWang023
• Status: Not yet recruiting
• Phase: N/A
• Start date: August 6, 2023
• Est. completion date: February 15, 2024

Study information

• Verified date: July 2023
• Source: Tianjin Medical University General Hospital
• Contact: Guolin Wang, MD
• Phone: +86 15822855556
• Email: wangguolinghad[@]hotmail.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Purpose:

To explore effects of ultrasound-guided quadratus lumborum block with compound lidocaine and esketamine on postoperative pain after colorectal surgery.

Description:

Poor post-surgical pain control is a leading factor that hinders the physicalrehabilitation, and causes acute cognitive impairment and chronic painsyndrome. Recently, the multimodal analgesia strategies to minimise opioidrelated side effects are highly desirable in open surgical procedures. Quadratus lumborum block is a novel technique. Although ropivacaine is most commonly used forthis technique, the analgesic duration remains not dissatisfied. Compared with ropivacaine, compound lidocaine injection has a better and longer analgesic activity since it contains menthol and ethanol with appropriate concentrations. However, whether compound lidocaine injection is efficiency in the quadratus lumborum block for abdominal surgery lacks investigations. Herein, we will evaluate the efficacy of ultrasound-guided quadratus lumborum block (USG-QLB) with compound lidocaine injection and esketamine for postoperative analgesia in patients undergoing colorectal surgery.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 160
• Est. completion date: February 15, 2024
• Est. primary completion date: January 15, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 20 Years to 65 Years

Eligibility

Inclusion Criteria:

1. Subject is scheduled to undergo colorectal cancer surgery under general anesthesia

2. Subject's American Society of Anesthesiologists physical status is I-III.

3. The subject's parent/legally authorized guardian has given written informed consent to participate

Exclusion Criteria:

1. Subject has a diagnosis of bronchial asthma, coronary heart disease, severe hypertension, renal failure or liver failure.

2. Subject has a diagnosis of Insulin dependent diabetes.

3. Subject is allergy and contraindication to local anesthetics or any components of local anesthetics.

4. Subject has a history of chronic pain, a history of alcohol or opioid abuse, pre- existing therapy with opioids, intake of any analgesic drug within 48 hours before surgery.

5. Subject has any contraindication for the use of patient-controlled analgesia (PCA).

6. Subject is pregnant or breast-feeding.

7. Subject is obese (body mass index >30kg/m^2).

8. Subject is incapacity to comprehend pain assessment and cognitive assessment.

Related Conditions & MeSH terms

• Pain, Postoperative
• Postoperative Pain

Intervention

Drug:
• Normal saline
After the induction of anesthesia, normal saline is used for bilateral quadratus lumborum block in a volume of 20 mL of each side
• Ropivacaine
After the induction of anesthesia, 0.375% ropivacaine is used for bilateral quadratus lumborum block in a volume of 20 mL of each side
• Compound lidocaine
After the induction of anesthesia, 0.6% compound lidocaine is used for bilateral quadratus lumborum block in a volume of 20 mL of each side
• Esketamine
After the induction of anesthesia, 0.4mg/kg esketamine is used for bilateral quadratus lumborum block

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Tianjin Medical University General Hospital

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Postoperative opioid consumption	Each patient was administered analgesics using a PCA (Patient-controlled analgesia) pump containing opioid in normal saline after leaving PACU (Postanesthesia care unit). Opioid cumulative consumption is recorded for 72 hours postoperatively.	72 hours after surgery
Secondary	Pain Score (NRS)	The pain score at rest or after movement was evaluated by pain 11-point numerical rating scale (NRS): 0 = no pain, 10= greatest imaginable pain.	72 hours after surgery
Secondary	Time of First Postoperative Analgesic Requirement	First postoperative pain (NRS=5) is initially controlled by titration of opioid.	1 hour after surgery
Secondary	Total Dose of First Postoperative Analgesic Requirement	First postoperative pain (NRS=5) is initially controlled by titration of opioid.	1 hour after surgery
Secondary	The incidence of Side Effects	The number of patients with side effects including nausea, vomiting, dizziness, headache, shivering, and pruritus is recorded for 72 hours postoperatively.	72 hours after surgery
Secondary	Apfel score	The Apfel score was recorded for evaluating risk for developing postoperative nausea and vomiting (PONV).	The 1 day before the surgery
Secondary	Mean time until passage of flatus	Gastrointestinal motility was evaluated by recording mean time until passage of flatus	96 hours after surgery
Secondary	Diffusion area of local anesthetics after quadratus lumborum block	Diffusion area of local anesthetics after quadratus lumborum block was calculated under ultrasound assistance.	30 minutes after quadratus lumborum block
Secondary	Normalized Area of Hyperalgesia Around the Incision	The skin around the incision is stimulated in steps of 5 mm at intervals of 1 s starting outside of the hyperalgesic area in the direction of the incision. The distance from the incision to the first point where a 'painful', 'sore' or 'sharper' feeling occurred is measured and noted. This measurement is repeated at predefined radial lines around the incision. To eliminate the variable length of incision, this length is subtracted from the longer diameter leaving four radial distances from the end and from the middle of the incision. The normalized area of hyperalgesia is calculated by summing up the areas of the remaining four triangles measured by and Von Frey filament.	72 hours after surgery
Secondary	The level of cytokines in blood By ELISA kits	Blood is collected to measure the level of cytokines (such as IL-18, IL-17, IL-23 ) using ELISA kits.	72 hours after surgery
Secondary	The level of chemokines in blood By ELISA kits	Blood is collected to measure the level of chemokines (such as CXCL1, CCL7, CCL2) using ELISA kits.	72 hours after surgery