BladderQLB: QLB and Radical Cystectomy, Postoperative Pain
There are ca 1000 new cases of bladder cancer in Finland/year. The curative therapy for high risk bladder cancer is radical cystectomy. The golden standard is still an open surgery despite development of laparoscopic techniques. Epidural analgesia is considered as most effective for the treatment of postoperative pain. However, there is a need for other effective options, because epidural analgesia has some contraindications and risks for serious complications. Recently quadratus lumborum block has gained popularity in the treatment of postoperative pain after various surgeries in the area from hip to mamilla. It is more beneficial than other peripheral blocks, since it covers also the visceral nerves. Contrary to the need of epidural catether a single shot QLB has reported to last up to 48 hours.
Inadequately treated acute postoperative pain is considered as one of the main risk factors for persistent postoperative pain.
44 patients aging 18-85 will be recruited based on a power calculation. The primary outcome measure is the acute postoperative need for rescue analgesics. Secondary outcomes are acute pain (NRS scale), nausea, vomiting, mobilisation and longterm outcomes such as quality of life and persistent pain.
|Condition or Disease||Intervention/Treatment||Phase|
44 patients, uindergoing radical cystectomy, aging 18-85 will be recruited based on a power calculation. The 44 patients will be divided in 2 groups, the intervention group receiving a quadratus lumborum block (75mg ropivacaine) and the no intervention group receiving the current standard care of our hospital -an epidural.
The primary outcome measure is the acute postoperative need for rescue analgesics. Secondary outcomes are acute pain (NRS scale), nausea, vomiting, mobilisation and longterm outcomes such as quality of life and persistent pain.
Arms and Interventions
|Experimental: Quadratus lumborum block|
Single shot bilateral QLB, ropivacaine 75 mg (20 mL) per side, placed under ultrasound control, at the end of surgery. 22 patients will be allocated in this group.
bilateral single shot block, placed under ultrasound control between the thoracolumbar fascial structures close to the quadratus lumborum muscle
|No Intervention: Epidural|
Epidural catheter (placed before anesthesia induction), ropivacaine 75 mg in 50 mL isotonic saline (1,5 mg/mL), induction bolus after surgery 1 mL/10 kg ideal weight and there on continuous infusion 2-8 mL/h according to analgesic need. 22 patients will be allocated in this group. This is the current standard for postoperative pain relief in cystectomy patients in our hospital
Primary Outcome Measures
- opiate consumption [24 hours]
intravenous patient controlled analgesia
Secondary Outcome Measures
- pain score [7 days]
numerical rating scale
- postoperative nausea and vomiting [72 hours]
numerical rating scale and amount of vomites
- mobilisation [72 hours after surgery]
standing up and mobilizing
- quality of life [12 months]
- persistent pain [12 months]
- functional query [12 months]
assessment how pain in operation region limits daily functions
- patients with bladder cancer coming to the open radical cystectomy.
age under 18y or over 85y,
diabetes type 1 with complications,
no co-operation or inadequate finnish language,
persistent pain for other reason.
Contacts and Locations
|1||Tampere University Hospital||Tampere||Finland||33521|
Sponsors and Collaborators
- Tampere University Hospital
- Study Director: Maija-Liisa Kalliomaki, PhD, Tampere University Hospital, Department of anesthesia
Study Documents (Full-Text)None provided.
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