ESP Block for Laparoscopic Nephrectomy Surgeries
Kidney Cancer, Post-surgical Pain
About this trial
This is an interventional treatment trial for Kidney Cancer
Eligibility Criteria
Inclusion Criteria:
- Patients requiring laparoscopic nephrectomy and partial nephrectomy for malignancy
- Patients of age 18 and over
- BMI < 40
- Patients who are expected to stay in-hospital overnight after surgery
Exclusion Criteria:
- Patient refusal
- Contraindications to paravertebral blocks: Infection at the site of needle insertion, empyema, allergy to local anesthetic drugs, and tumor occupying the thoracic paravertebral space, coagulopathy, bleeding disorder or therapeutic anticoagulation
- Known allergy to local anesthetics
- Inability to provide informed consent
- Inability to use a PCA due to languate or comprehension barriers
- BMI >= 40
- Any patient on opioids for greater than or equal to 3 months duration prior to surgery
- Patients with chronic pain syndromes
- Donor nephrectomies due to incision location
- Cystic kidney because of very large incisions
Sites / Locations
- St. Joseph's Healthcare HamiltonRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Sham Comparator
Ultrasound-guided continuous ESP block with opioid PCA
Ultrasound-guided sham block and catheter with opioid PCA
A high-frequency linear ultrasound transducer will be placed in a longitudinal parasagittal orientation 3 cm lateral to the T7/T8 spinous process. The patient's skin will be anesthetized with 2% lidocaine. A Contiplex Echo ultra 360 18G needle with 20G × 55 cm Contiplex Echo catheter will be inserted using an in-plane superior-to-inferior approach to place the tip into the fascial plane on the deep (anterior) aspect of erector spinae muscle. The location of the needle tip will be confirmed by visible fluid spread lifting erector spinae muscle off the bony shadow of the transverse process. A total of 30 mL of 0.375% ropivacaine with 5mcg/mL of epinephrine will be injected in 5-mL aliquots through the needle (maximum of 3mg/kg) followed by insertion of the echo catheter system under direct vision 2-3 cm beyond the needle tip.
The exact same procedure as the experimental group will be followed, substituting saline for local anesthetic at the same amounts and rate. As with the ESP group, the patients will have PCA initiated postoperatively in the PACU at the same doses.