Quadratus Lumborum Block for Percutaneous Nephrostomy

Regional Anesthesia Morbidity Clinical Trial

— QLB  

Official title:

Quadratus Lumborum Block Versus Local Anesthetic Infiltration Combined With Monitored Anesthesia Care for Percutaneous Nephrostomy

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT02121951
• Other study ID #: Quadratus Lumborum Block
• Status: Withdrawn
• Phase: Phase 4
• First received: April 20, 2014
• Last updated: April 8, 2018
• Start date: May 2014
• Est. completion date: August 2014

Study information

• Verified date: April 2018
• Source: National Cancer Institute, Egypt
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Percutaneous nephrostomy (PCN) is one of the interventions in the radiology department in which pain control is necessary. Quadratus Lumborum (QL) block will be tried to limit the use of systemic analgesics and its accompanying untoward effects in those frail patients requiring PCN that is performed in the prone position.

Description:

Quadratus Lumborum block is a novel technique in which extension into the thoracic paravertebral space may occur. QL block would seem to be able to alleviate both somatic and visceral pain so it's expected to decrease the need for systemic sedation\analgesia to a minimum.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. completion date: August 2014
• Est. primary completion date: May 2014
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

1. ASA grade III and IV patients,

2. Ureteral obstruction due to malignancy or secondary to urinary diversion after cystectomy

Exclusion Criteria:

1. Bleeding diathesis; INR more than than 1.5 and platelet count less than 100,000/mm3.

2. Untreated urinary tract infection;

3. Pre-operative haemoglobin <10 gm/dl,

4. Severely co morbid patients

5. Non-dilated renal collecting system

6. Patient refusal to consent for the procedure.

Related Conditions & MeSH terms

• Adverse Anesthesia Outcome
• Nephrostomy; Complications
• Regional Anesthesia Morbidity
• Upper Urinary Tract Dilatation and Obstruction

Intervention

Procedure:
• Local Anesthetic infiltration
Lignocaine infiltration through the nephrostomy track
• Quadratus Lumborum block
A linear 12-MHz ultrasound probe will be placed in the anterior axillary line to visualize the typical triple abdominal layers. Then, the probe will be placed in the midaxillary line and at this point the layers of abdominal layers starte to taper. The probe will be placed in the posterior axillary line, sonoanatomy will show first the transversus abdominis disappearing then the internal oblique and external oblique forming aponeurosis and appearance of QL will be noticed. At the posterior border of the quadratus lumborum muscle and outside the fascia, Touhe needle will be inserted in plane and confirmed its position by injecting saline. Under ultrasound (US) guidance, local anesthetic mixure will be deposited separating the fascia

Drug:
• MAC
Incremental doses are given to the targed sedation and analgesia

Locations

Country	Name	City	State
Egypt	National Cancer Institute	Cairo	Old Cairo

Sponsors (1)

Lead Sponsor	Collaborator
National Cancer Institute, Egypt

Country where clinical trial is conducted

Egypt, 

References & Publications (2)

Ironfield CM, Barrington MJ, Kluger R, Sites B. Are patients satisfied after peripheral nerve blockade? Results from an International Registry of Regional Anesthesia. Reg Anesth Pain Med. 2014 Jan-Feb;39(1):48-55. doi: 10.1097/AAP.0000000000000038. — View Citation

Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol. 2013 Oct;29(4):550-2. doi: 10.4103/0970-9185.119148. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Analgesia	Verbal Rating Scale is assessed for degree of pain during the procedure and after till discharge from the radiology department.	4 hours
Secondary	Respiratory Depression	Respiratory rate and airway patency is monitored with an anesthesiologist.	4 hours
Secondary	Sedation	Ramsay Seadation Score is assessed during and after procedure till discharge	4 hours
Secondary	Cardiovascular stability	Blood pressure and Heart rate is assessed during and after procedure till discharge	4 hours
Secondary	Patient Satisfaction	Patient Satisfaction Quistionaire	48 hours

External Links

•   Optimal point of injection: The quadratus lumborum type I and II blocks