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Quadratus lumborum block as an alternative for postoperative analgesia compared with epidural block
Epidural analgesia is the main choice of analgesia following kidney transplant surgery. However, continuous epidural technique had some concerning side effects such as hemodynamic instabilities, urine retention, motor/sensory disturbances/weakness, and mobilisation comfort, it could also cause hypotension which could affect graft success. Quadratus lumborum (QL) block had lesser side effects thus could be an option for postoperative analgesia, however there are no study showing the safety and success rate of QL block techniques for patients who underwent kidney transplant surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Continuous Epidural Analgesia | Active Comparator | Continuous epidural analgesia using ropivacaine 0.375% 3 mL boluses followed by ropivacaine 0.2% with rate 6 mL per hour for 24 hours |
|
| Bilateral Quadratus Lumborum Block | Experimental | Bilateral Quadratus lumborum block using ropivacaine 0.2% 20 mL each injection after surgery |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Continuous Epidural analgesia | Procedure | Continuous Epidural catheter is inserted at the Thoracic 11-T12 level, using Ropivacaine 0.375% 3 mL bolus followed by Ropivacaine 0.2% with rate 6 mL/hour for 24 hours after laparoscopic nephrectomy |
| Measure | Description | Time Frame |
|---|---|---|
| Morphine consumption | Additional analgesia required at 2, 6, 12, and 24 hours after surgery | 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Pain Intensity | Pain intensity measured using the Visual Analogue Scale (VAS) at 2, 6, 12, and 24 hours after surgery. VAS assessed with horizontal line 0-100 mm for no pain to the worst pain, with range 0-30 mm for none to mild pain, 31-70 mm for moderate pain, 71-100 mm for severe pain. | 24 hours |
| First time morphine required |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Dita Aditianingsih, M.D. | Indonesia University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Rumah Sakit Cipto Mangunkusumo | Jakarta Pusat | DKI Jakarta | 10430 | Indonesia |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | Mochtar CA, Alfarissi F, Soeroto AA, Hamid ARAH, Wahyudi I, Marbun MBH, et al. Milestones of kidney transplantation in Indonesia. Med J Indones. 2017 Nov 27;26(3):229. | ||
| Background | Kakaei F, Nikeghbalian S, Ali S. Kidney Transplantation Techniques. In: Rath T, editor. Current Issues and Future Direction in Kidney Transplantation [Internet]. InTech; 2013 [cited 2018 Jun 6]. Available from: http://www.intechopen.com/books/current-issues-and-future-direction-in-kidney-transplantation/kidney-transplantation-techniques | ||
| 28979781 | Background | Pham PC, Khaing K, Sievers TM, Pham PM, Miller JM, Pham SV, Pham PA, Pham PT. 2017 update on pain management in patients with chronic kidney disease. Clin Kidney J. 2017 Oct;10(5):688-697. doi: 10.1093/ckj/sfx080. Epub 2017 Aug 18. | |
| Background |
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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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| Bilateral Quadratus Lumborum block | Procedure | Bilateral anterior Quadratus Lumborum block using Ropivacaine 0.375% 20 mL each injection as postoperative analgesia treatment for 24 hours |
|
Total time gap from postoperative analgesia procedure administration to first morphine requirement |
| 24 hours |
| Total minimum and maximum dose of vasoactive agents | Minimum and maximum dose of norepinephrine and dobutamine as vasoactive agents within 24 hours after surgery | 24 hours |
| Urine output | Urine output (mL/kgBW/hour) after surgery | 24 hours |
| Bromage score | Bromage score at 2, 6, 12, and 24 hours after surgery to assess lower limb motoric block. Score for Bromage:
| 24 hours |
| Ramsay score | Ramsay score at 2, 6, 12, and 24 hours after surgery to assess patient sedation level. | 24 hours |
| Dermatomal coverage of analgesia procedure | dermatome sensory block distribution using cold sensation test | Immediately after anaesthesia completion |
| Blood ropivacaine level | Arterial blood sample of all subjects will be withdrawn approximately 3 mL from the arterial line at 0, 30, 45, 60 minute, and 2, 4, 6,12,18, 24 hours after designated analgesia procedure, and will be used for ropivacaine blood level measurements using High-Performance Liquid Chromatography (HPLC), to measure Total plasma ropivacaine concentration (Cstop), maximum plasma concentration (Cmax), time of maximum plasma concentration, area under the curve (AUC) | 24 hours |
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| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |