Quadratus Lumborum Block After Living Donor Kidney Transplantation
Study Details
Study Description
Brief Summary
The aim of this study is to evaluate the postoperative analgesic effect of quadratus lumborum block in patient undergoing a living donor kidney transplant under general anesthesia.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
The purpose of this study was to investigate whether postoperative pain is significantly reduced when TQL block was additionally performed after surgery in patients undergoing living-donor kidney transplantation. Therefore, investigator hypothesized that the analgesic consumption for postoperative 24 hours will decrease in TQL group compared to the control group. For secondary outcomes, the pain score at rest/ movement up to 48 hours after surgery, the time until the first pain reliever is requested, whether and how often rescue analgesics are administered for 48 hours, the incidence and severity of nausea and vomiting during the 48 hours after surgery, patient's satisfaction with post-pain control and the number of hospital stays were investigated. Overall, the aim of this study is to evaluate the postoperative analgesic effect of quadratus lumborum block in patients undergoing a living donor kidney transplantation under general anesthesia.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Transmuscular quadratus lumborum block group Patients assigned to the Transmuscular Quadratus Lumborum (TQL) block group receive the Transmuscular Quadratus Lumborum block in a lateral decubitus position with the surgical site facing up before recovery of general anesthesia after surgery. For the block, 30cc of 0.375% ropivacaine is used. |
Procedure: Transmuscular quadratus lumborum block
Patients assigned to the TQL block group receive the TQL block in a supine position with the surgical site facing up before recovery of general anesthesia after surgery. For the block, 30cc of 0.375% ropivacaine is used.
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| Placebo Comparator: Control group For patients assigned to the control group, 30cc of 0.9% normal saline is used for Transmuscular Quadratus Lumborum block. |
Procedure: Placebo
For patients assigned to the control group, 30cc of 0.9% normal saline is used for TQL block.
|
Outcome Measures
Primary Outcome Measures
- Analgesic consumption for 24 postoperative hours [24 hours postoperatively]
Total analgesic use for 24 hours after surgery (morphine milligram equivalents (MME))
Secondary Outcome Measures
- Analgesic consumption [at postoperative 6, 12, 48 hours]
Analgesic consumption at postoperative 6, 12, 48 hours
- Resting pain numeric rating scale(NRS) [at postoperative 6, 12, 24, 48 hours]
Resting pain numeric rating scale(NRS) at postoperative 6, 12, 24, 48 hours. Numeric rating scare is 11-point scale from 0 to 10, The higher the number, the more severe the pain (0 is no pain at all, 10 is the most severe pain imaginable).
- Numeric rating scale of pain during movement [at postoperative 6, 12, 24, 48 hours]
Numeric rating scale of pain during movement at postoperative 6, 12, 24, 48 hours Numeric rating scare is 11-point scale from 0 to 10. The higher the number, the more severe the pain (0 is no pain at all, 10 is the most severe pain imaginable).
- Time to first rescue analgesics [within post-operative 24 hours]
Time to first rescue analgesics
- Numeric rating scale at post anesthetic care unit (PACU) [30 minutes after the end of operation]
Numeric rating scale at post anesthetic care unit Numeric rating scare is 11-point scale from 0 to 10. The higher the number, the more severe the pain (0 is no pain at all, 10 is the most severe pain imaginable).
- Rescue analgesics administration [within post-operative 48 hours]
Rescue analgesics administration count
- The incidence of post-operative nausea and vomiting [within post-operative 48 hours]
The incidence of post-operative nausea and vomiting
- Patient satisfaction with pain control [At post-operative 48 hours]
Patient satisfaction with pain control in 11 point scale (0-10), The higher the score, the higher the patient's satisfaction.
- Pattern of injectate spread on ultrasonography [During procedure quadratus lumborum (QL) block]
Pattern of injectate spread on ultrasonography
- Sensory blockade [30 minutes after the end of operation]
After surgery, an alcohol swab is used to evaluate the loss of cold sensation. It is evaluated by dividing into nine regions bordering the rib margin on the side of the surgery, the horizontal line passing through the umbilicus and pubis, and the vertical line of the midclavicular line, anterior axillary line, and mid axillary line. If cold sensation is the same as the opposite part of the regions, marked as 2 points, if decreased marked as 1 point, and if not sensed at all, marked as 0 point.
- Quality of Recovery Questionnaire (15-item Quality of Recovery) [At post-operative 48 hours]
Each item uses an 11-point numeric rating scale. The sum of the scores of the 15 items ranges from 0 to 150, with a high score indicating good quality of recovery.
- The severity of post-operative nausea and vomiting [within post-operative 48 hours]
The severity of post-operative nausea and vomiting, The severity of the nausea and vomitting is asked to patient and expressed as none, mild, or severe.
Eligibility Criteria
Criteria
Inclusion Criteria:
- Patients over 19 years of age undergoing elective living donor kidney transplantation under general anesthesia in Seoul National University Hospital
Exclusion Criteria:
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Patients with severe pain before surgery
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Patients with a history hypersensitivity reactions on fentanyl or ropivacaine
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Patients who cannot maintain patient-controlled analgesia (PCA) by themselves
④ Patients with skin diseases or infections in the area where quadratus lumborum block is applied
⑤ Any other cases that researchers determine that it is inappropriate for this clinical trial
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Seoul National University Hospital | Seoul | Korea, Republic of | 03080 |
Sponsors and Collaborators
- Seoul National University Hospital
Investigators
- Principal Investigator: Sun-Kyung Park, M.D.,Ph.D, Seoul National University Hospital
Study Documents (Full-Text)
None provided.More Information
Publications
- de Boer HD, Detriche O, Forget P. Opioid-related side effects: Postoperative ileus, urinary retention, nausea and vomiting, and shivering. A review of the literature. Best Pract Res Clin Anaesthesiol. 2017 Dec;31(4):499-504. doi: 10.1016/j.bpa.2017.07.002. Epub 2017 Jul 8. Review.
- Freir NM, Murphy C, Mugawar M, Linnane A, Cunningham AJ. Transversus abdominis plane block for analgesia in renal transplantation: a randomized controlled trial. Anesth Analg. 2012 Oct;115(4):953-7. Epub 2012 Jul 4.
- Jun JH, Kim GS, Lee JJ, Ko JS, Kim SJ, Jeon PH. Comparison of intrathecal morphine and surgical-site infusion of ropivacaine as adjuncts to intravenous patient-controlled analgesia in living-donor kidney transplant recipients. Singapore Med J. 2017 Nov;58(11):666-673. doi: 10.11622/smedj.2017077. Epub 2017 Aug 14.
- Korgvee A, Junttila E, Koskinen H, Huhtala H, Kalliomaki ML. Ultrasound-guided quadratus lumborum block for postoperative analgesia: A systematic review and meta-analysis. Eur J Anaesthesiol. 2021 Feb 1;38(2):115-129. doi: 10.1097/EJA.0000000000001368.
- Kruszyna T, Niekowal B, Kraśnicka M, Sadowski J. Enhanced Recovery After Kidney Transplantation Surgery. Transplant Proc. 2016 Jun;48(5):1461-5. doi: 10.1016/j.transproceed.2015.11.037.
- Rohan VS, Taber DJ, Patel N, Perez C, Pilch N, Parks S, Bolin E, Nadig SN, Baliga PK, Fleming JN. Impact of a multidisciplinary multimodal opioid minimization initiative in kidney transplant recipients. Clin Transplant. 2020 Oct;34(10):e14006. doi: 10.1111/ctr.14006. Epub 2020 Sep 4.
- Territo A, Mottrie A, Abaza R, Rogers C, Menon M, Bhandari M, Ahlawat R, Breda A. Robotic kidney transplantation: current status and future perspectives. Minerva Urol Nefrol. 2017 Feb;69(1):5-13. doi: 10.23736/S0393-2249.16.02856-3. Epub 2016 Nov 30. Review.
- Uppal V, Retter S, Kehoe E, McKeen DM. Quadratus lumborum block for postoperative analgesia: a systematic review and meta-analysis. Can J Anaesth. 2020 Nov;67(11):1557-1575. doi: 10.1007/s12630-020-01793-3. Epub 2020 Aug 17.
- Yang P, Luo Y, Lin L, Zhang H, Liu Y, Li Y. The efficacy of transversus abdominis plane block with or without dexmedetomidine for postoperative analgesia in renal transplantation. A randomized controlled trial. Int J Surg. 2020 Jul;79:196-201. doi: 10.1016/j.ijsu.2020.05.073. Epub 2020 Jun 2.
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