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This study aimed to compare the efficacy of ultrasound guided trans-muscular quadratus lumborum Block, thoracolumbar interfascial plane block and local anesthetic infiltration for elective lumbar spine fixation undergo up to three-level fixation.
Back and leg pain arising from lumbar spine surgery is widespread, and its treatment can range from pharmacotherapy to surgical intervention. A majority of patients who undergo spinal surgery report experiencing moderate pain six months after the operation.
Interfascial plane blocks, including the thoracolumbar interfascial plane (TLIP) block target these posterior rami passing through the paraspinal muscles. Several studies have explored the analgesic efficacy of TLIP block in posterior lumbar spine surgery.
Quadratus lumborum block (QLB) is a posterior abdominal wall fascial block where local anesthetic is administered around QL muscle. play a significant role in contemporary medical practice for enhancing post-spinal surgery pain management.
Local infiltrative analgesia applied in layers of the surgical wound layers has been suggested as an appealing alternative due to its simplicity, enhanced safety, and limited cost, also a popular modality for postoperative analgesia in spine surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group I: QLB group | Experimental | Patients received general anesthesia and bilateral ultrasound guided trans-muscular quadratus lumborum block (QLB 3) with (20 ml Bupivacaine 0.25% each side) + (Dexmedetomidine 0.5 mic/kg) for each side as total volume (1 mic/kg). |
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| Group II: TLIP block group | Experimental | Patients received general anesthesia and bilateral ultrasound guided thoracolumbar interfascial plane block with (20ml of Bupivacaine 0.25%) for each side + (Dexmedetomidine 0.5 mic/kg) for each side as total volume (1 mic/kg). |
|
| Group III: Local wound infiltration group | Experimental | Patients received general anesthesia and local anesthetic infiltration at the side of incision before with (40 ml of Bupivacaine 0.25%) + (Dexmedetomidine 1mic/kg). |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Quadratus lumborum block | Other | Patients received general anesthesia and bilateral ultrasound guided trans-muscular quadratus lumborum block (QLB 3) with (20 ml Bupivacaine 0.25% each side) + (Dexmedetomidine 0.5 mic/kg) for each side as total volume (1 mic/kg). |
| Measure | Description | Time Frame |
|---|---|---|
| Total morphine consumption | Intravenous morphine (0.05mg/kg) was given when numeric rating scale (NRS) equal or above 4. | 24 hours postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Mean arterial pressure | Mean arterial pressure was recorded before induction of anesthesia (base-line value), after prone position, at the time of skin incision and after skin incision by 5,15 and 30 minutes, and at the end of the operation. | Till end of surgery (Up to 2 hours) |
| Heart rate |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Tanta University | Tanta | El-Gharbia | 31527 | Egypt |
The data will be available upon a reasonable request from the corresponding author after the end of study for one year.
After the end of study for one year.
The data will be available upon a reasonable request from the corresponding author.
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| Thoracolumbar interfascial plane block | Other | Patients received general anesthesia and bilateral ultrasound guided thoracolumbar interfascial plane block with (20ml of Bupivacaine 0.25%) for each side + (Dexmedetomidine 0.5 mic/kg) for each side as total volume (1 mic/kg). |
|
| Local anesthetic infiltration | Other | Patients received general anesthesia and local anesthetic infiltration at the side of incision before with (40 ml of Bupivacaine 0.25%) + (Dexmedetomidine 1mic/kg). |
|
Heart rate was recorded before induction of anesthesia (base-line value), after prone position, at the time of skin incision and after skin incision by 5,15 and 30 minutes, and at the end of the operation. |
| Till end of surgery (Up to 2 hours) |
| Time to the first request for rescue analgesia | Time to the first request for rescue analgesia was recorded from the end of surgery till first dose of morphine administrated. | 24 hours postoperatively |
| Degree of pain | Each patient was instructed about postoperative pain assessment with the numeric rating scale (NRS) score. NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). NRS were the 0th (PACU), 1th, 3rd, 6th, 12th, and 24th postoperative hours. | 24 hours postoperatively |