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The main advantage of Quadratus Lumborum Block (QLB) compared to Transversus Abdominalis Plane Block (TAPB) is the impact on visceral pain due to the spread of the local anaesthetic agent to the paravertebral space. It may produce extensive analgesia and better pain control.
Previews studies shoved the effectiveness of TAPB in kidney transplantation procedure (KTX) by reducing opioids requirements during and after the operation. QLB was not evaluating in KTX procedure yet, but it reduced postoperative morphine requirement after cesarean section under spinal anaesthesia.
The aim of this prospective, randomised controlled, multicenter, clinical study is to compare the perioperative analgesic efficacy of QLB and TAPB in patients who had KTX under balanced (general and regional) anaesthesia.
After Bioethical Committee of Medical University of Warsaw approval, informed written consent will be obtained from all patients.
A sample size of 104 patients was calculated to obtain at list 25% reduction of fentanyl usage in QLBII group with 0,05% significance and power of 0,8. Consenting patients, scheduled to KTX procedure under general anaesthesia will be randomly assigned (1:1) according to the computer -generated randomization list with permuted blocks (block sizes: 20, 20, 24, 40) to receive 20ml of 0,25% Bupivacaine with epinephrine ipsilaterally to the operation side in QLBII or TAPB after the general anaesthesia induction and before the surgery starts. All the blocks will be performed in the supine patients position, under ultrasound guidance for both techniques. The correct spread of injectate will be confirmed with ultrasound.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Quadratus Lumborum Block type II | Experimental | Unilateral ultrasound guidance QLB on the operated side after induction of general anaesthesia - 20 ml of 0,25%bupivacaine with adrenaline injected with ultraplex needle |
|
| Transversus Abdominalis Plane Block | Active Comparator | Unilateral ultrasound guidance TAPB on the operated side after induction of general anaesthesia - 20 ml of 0,25% bupivacaine with adrenaline injected with ultraplex needle |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Quadratus Lumborum Block type II | Procedure | Local anaesthetic injection on the posterior border of the quadratus lumborum muscle |
|
| Measure | Description | Time Frame |
|---|---|---|
| Total postoperative fentanyl usage | Total cumulative fentanyl dose used in the first 24 hours after surgery | 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Time to first analgesic (TTFA) | Time from the end of surgery to the first postoperative intravenous fentanyl administered from intravenous patient controlled analgesia ( IVPCA) device. | 24 hours |
| Postoperative pain severity in Numerical Rating Scale (NRS) in the first 24 hours after surgery |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Marcin Kolacz, MD,PhD | Medical University of Warsaw | Study Director |
| Marcin Mieszkowski, MD | Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Poland | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| I Department of Anaesthesiology and Intensive Care, Medical University of Warsaw | Warsaw | 02-005 | Poland |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32175985 | Derived | Kolacz M, Mieszkowski M, Janiak M, Zagorski K, Byszewska B, Weryk-Dysko M, Onichimowski D, Trzebicki J. Transversus abdominis plane block versus quadratus lumborum block type 2 for analgesia in renal transplantation: A randomised trial. Eur J Anaesthesiol. 2020 Sep;37(9):773-789. doi: 10.1097/EJA.0000000000001193. |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| ID | Term |
|---|---|
| D002045 | Bupivacaine |
| ID | Term |
|---|---|
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
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| Transversus Abdominalis Plane Block | Procedure | Local anaesthetic injection between internal oblique and transversus abdominis muscle |
|
| Bupivacaine | Drug | 20 ml of bupivacaine with adrenaline |
|
|
| Ultraplex | Device | A non-stimulating echogenic single-shot needle designed for regional analgesia under ultrasound guidance. |
|
NRS range from 0 for no pain to 10 for worst pain imaginable. |
| 24 hours |
| Nausea or vomiting | 0- no nausea; 1- mild nausea; 2- moderate nausea; 3- severe nausea or vomiting | 24 hours |
| Sedation Level | 1 - responds to normal verbal communication; 2 - drowsy, but responds to verbal communication; 3- asleep, but awakes with verbal communication; 4- asleep, awakens with mild physical stimulation. 5- asleep, unresponsive to physical stimulation. | 24 hours |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D000588 |
| Amines |