Quadratus Lumborum Versus Transversus Abdominis Plane Nerve Block: A Comparison Study

• Sponsor: Medical University of South Carolina (Other)
• Overall Status: Recruiting
• CT.gov ID: NCT03490357
• Collaborator: (none)
• Enrollment: 180
• Location: 1
• Arms: 2
• Anticipated Duration (Months): 60.6
• Patients Per Site Per Month: 3

Study Details

Study Description

Brief Summary

The Transversus Abdominis Plane (TAP) block is the current standard of care for patients undergoing laparoscopic abdominal surgeries with the Enhanced Recovery After Surgery (ERAS) Protocol. The Quadratus Lumborum (QL) is another established abdominal fascial plane block that is comparable in procedure and risks and may potentially be more beneficial. The study compares the two blocks in hopes of establishing a new standard of care for patients undergoing laparoscopic abdominal surgeries with the ERAS protocol.

Condition or Disease	Intervention/Treatment	Phase
Anesthesia	Procedure: Control - Transversus Abdominus Plane Block; Procedure: Quadratus Lumborum Block	N/A

Detailed Description

The Transversus Abdominis Plane (TAP) block is the current standard of care for patients undergoing laparoscopic abdominal surgeries with the Enhanced Recovery After Surgery (ERAS) Protocol. The Quadratus Lumborum (QL) is another established abdominal fascial plane block that is comparable in procedure and risks and may potentially be more beneficial. The study compares the two blocks in hopes of establishing a new standard of care for patients undergoing laparoscopic abdominal surgeries with the ERAS protocol.

• Compare QL and TAP blocks cephalad spread via mapping in the Postoperative Acute Care Unit (PACU) within 6 hours after block placement.

• Compare efficacy of blocks via Visual Analogue Scale (VAS) pain scores in PACU and postoperative day (POD) 1.

• Compare amount of opioid pain medications consumed within 24 hours after block. Hypothesis

• The QL block will prove superior to the TAP block in both cephalad spread and pain control for abdominal surgery patients and decrease the amount of opioid pain medications required while in effect up to 24 hours after surgery.

• The quadratus lumborum will have increased cephalad spread. We predict mapping will show greater (2 or more dermatomal levels) or equal analgesic coverage by the QL block when compared to the TAP block.

Study Design

• Study Type: Interventional
• Anticipated Enrollment: 180 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Intervention Model Description: The expected cephalad dermatomal distribution of the TAP block is T10. A positive outcome is a QL block with patient anesthesia at 2 or more dermatomes higher than the TAP block. The investigators will assume that there is a 30% difference between the two blocks, which leads to between 24 and 33 patients in each arm (ideally aiming for 30 patients in each group). The investigators have included other sample sizes should they find that there is a higher or lower percentage difference between the QL and TAP blocks. Outcome: A positive block is considered anesthesia at T8 or above and a negative block is considered analgesia below T8The expected cephalad dermatomal distribution of the TAP block is T10. A positive outcome is a QL block with patient anesthesia at 2 or more dermatomes higher than the TAP block. The investigators will assume that there is a 30% difference between the two blocks, which leads to between 24 and 33 patients in each arm (ideally aiming for 30 patients in each group). The investigators have included other sample sizes should they find that there is a higher or lower percentage difference between the QL and TAP blocks. Outcome: A positive block is considered anesthesia at T8 or above and a negative block is considered analgesia below T8
• Masking: Double (Participant, Outcomes Assessor)
• Masking Description: Outcome assessor and patient blinded to type of block that the patient receives. Outcome assessor will check dermatomal levels after surgery.
• Primary Purpose: Treatment
• Official Title: Quadratus Lumborum Versus Transversus Abdominis Plane Nerve Block: A Comparison in Regional Anesthesia Techniques With an Enhanced Recovery After Surgery Pathway
• Actual Study Start Date: May 15, 2018
• Anticipated Primary Completion Date: Dec 1, 2022
• Anticipated Study Completion Date: Jun 1, 2023

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Control - Transversus Abdominus Plane Block Standardized ERAS regional nerve block	Procedure: Control - Transversus Abdominus Plane Block; Abdominal fascial plane block - regional anesthesia
Experimental: Quadratus Lumborum Block Quadratus lumborum nerve block	Procedure: Quadratus Lumborum Block; Abdominal fascial plane block - regional anesthesia

Outcome Measures

Primary Outcome Measures

1. Dermatomal Mapping [6 hours]

   The primary outcome of interest is the proportion of subjects reporting a positive block. This is determined by dermatomal mapping in cephalad direction in PACU within 6 hours of TAP or QL placement. A positive outcome is one where the QL block measures 2 or more dermatomal levels higher than the TAP block

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Inclusion Criteria:

• • Patients scheduled for laparoscopic abdominal surgery as posted by the surgeon

• Part of the ERAS protocol as listed by the surgeon

• Age 18 years and older

• Elective procedure

Exclusion Criteria:

• • Patient inability to consent

• Patient inability to communicate for data collection

• Conversion from laparoscopic to open case

• Local anesthetic allergy

• Weight less than 50 kg

• Anatomical variation making block visualization unlikely

• Inability to cooperate with block

• Surgery posted longer than 6 hours

• Known preoperative substance abuse

• Chronic opioid use > 3 months

• Patient exhibits dependence on opioids Daily opioid use for pain control

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	The Medical University of South Carolina	Charleston	South Carolina	United States	29425

Sponsors and Collaborators

• Medical University of South Carolina

Investigators

• Principal Investigator: Renuka M George, MD, Medical University of South Carolina

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: Medical University of South Carolina
• ClinicalTrials.gov Identifier: NCT03490357
• Other Study ID Numbers: Pro00075597
• First Posted: Apr 6, 2018
• Last Update Posted: Feb 1, 2022
• Last Verified: Jan 1, 2022

• Individual Participant Data (IPD) Sharing Statement: No
• Plan to Share IPD: No
• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Study Results

No Results Posted as of Feb 1, 2022