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Quadratus Lumborum Block for Total Abdominal Hysterectomy

Primary Purpose

Postoperative Pain

Status
Recruiting
Phase
Not Applicable
Locations
Serbia
Study Type
Interventional
Intervention
QLB
Sponsored by
Clinical Center Niš
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Postoperative Pain focused on measuring Quadratus lumborum block, Postoperative analgesia

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria: endometrial carcinoma or uterine fibroids American society of anesthesiologists (ASA) physical status 1-3, Participant's body weight > 50 kg, Written informed consent signed. Exclusion Criteria: Patient's refusal Allergies to any study medication Local skin infection on the site of QLB injection 3. Body mass index > 40 kg/m2 4. Inability to comprehend or participate in scoring scales 4. Deformations that could possibly affect the spread of the local anesthetic in the quadratus lumborum muscle plane 5. Quadratus lumborum muscle plane not seen in ultrasound examination 6. Patients on regular use of opioids 7. Psychiatric disorders

Sites / Locations

  • CCNisRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

QLB group

Control group

Arm Description

At the end of surgery, before emergence of anesthesia, participants will receive bilateral QLB and intravenous (IV) ketoprofen 100 mg. Ketoprofen 100 mg IV will be repeated every 12 hours. For breakthrough pain patients will receive an IV bolus of morphine 5 mg. IV bolus can be repeated after 20 min. The maximum is 8 boluses for 4 hours.

At the end of surgery, before emergence of anesthesia, participants will receive IV ketoprofen 100 mg. Ketoprofen 100 mg IV will be repeated every 12 hours. For breakthrough pain patients will receive an IV bolus of morphine 5 mg. IV bolus can be repeated after 20 min. The maximum is 8 boluses for 4 hours.

Outcomes

Primary Outcome Measures

Morphine consumption (mg) during the first 12 postoperative hours
Total dose of IV morphine that participants received during the first 12 hours after surgery

Secondary Outcome Measures

Pain at rest
Pain at rest at NRS (Numeric rating scale score 0-10)
Pain at mobilization
Pain at mobilization at NRS (Numeric rating scale score 0-10)
Cumulated morphine consumption (mg) at 24 hours postoperatively
Total dose of IV morphine that participants received during the first 24 hours after surgery
Time to first morphine demand
Time to first request for rescue analgesia (morphine) after the end of surgery

Full Information

First Posted
March 1, 2023
Last Updated
March 14, 2023
Sponsor
Clinical Center Niš
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1. Study Identification

Unique Protocol Identification Number
NCT05765318
Brief Title
Quadratus Lumborum Block for Total Abdominal Hysterectomy
Official Title
Quadratus Lumborum Block for Total Abdominal Hysterectomy: a Double-blind, Randomized, Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 27, 2023 (Actual)
Primary Completion Date
July 27, 2023 (Anticipated)
Study Completion Date
July 28, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Clinical Center Niš

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
Procedure specific postoperative pain management (PROSPECT) guidelines for abdominal hysterectomy published in 2006 recommended laparoscopic or vaginal hysterectomy as a preferred surgical technique. Multimodal postoperative pain management plane includes cyclooxygenase-2 (COX-2) selective inhibitors, and/or conventional non-steroidal antiinflammatory drugs (NSAID) in combination with strong opioids for high-intensity pain or with weak opioids for moderate- or low-intensity pain. Paracetamol also was recommended in combination with COX-2 inhibitors or conventional NSAIDs. Epidural analgesia was recommended for high-risk patients. PROSPECT guidelines updated in 2018 discuss only perioperative approach for laparoscopic hysterectomy. However, hysterectomy technique has been switched from total abdominal to laparoscopic approach. In low resources settings, laparoscopic technique is nor well developed neither available to many patients. Furthermore, the majority of patients undergo total abdominal hysterectomy (TAH), that is very painful procedure. Quadratus lumborum block (QLB) is a regional analgesic technique described by Blanco in 2007. Society for Obstetric Anesthesiology and Perinatology (SOAP) and European Society for Regional Anaesthesia and Pain Therapy (ESRA) recommended QLB for post-Cesarean pain management in cases where intrathecal morphine could not be used or for breakthrough pain. Previous reports have shown that QLB is effective in providing pain relief after various abdominal operations. The effects of QLB for laparoscopic hysterectomy is controversial. We would like to see if QLB can provide analgesic benefits in multimodal pain management after TAH in our clinical settings.
Detailed Description
Participants will be randomly allocated into two groups. Experimental group will have QLB type 2 at the end of surgery, before emergence from general anesthesia. Control group will not have QLB. All cases will be done under general anesthesia. During the surgery, the patients will be monitored with 5-lead electrocardiography, pulse oximetry, non-invasive blood pressure and end-expiratory CO2. Standardized general anesthesia include induction with a propofol bolus of 1.5-2.5mg/kg and rocuronium 0.6mg/kg. Fentanyl 2 mcg/kg will be given at induction, and repeated to keep the blood pressure and heart rate changes up to 20% of baseline. Sevoflurane in a 50% air/50% oxygen mixture with an end-tidal of 1.5 vol% will be used as the maintenance agent. Mechanical ventilation will be maintained to keep the end-expiratory CO2 values between 34 and 36 mmHg. Incremental dose of rocuronium (0.15 mg/kg) will be given every 30 min or when needed. At the end of the surgery, after partial recovery from neuromuscular blockade, patients will receive atropine 0.01 mg/kg and neostigmine: 0.02mg/kg before tracheal extubation. Participants will be referred to the post-anesthesia recovery room after extubation and adequate hemodynamic and respiratory recovery. Postoperative pain management will include ketoprofen and morphine.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Postoperative Pain
Keywords
Quadratus lumborum block, Postoperative analgesia

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantOutcomes Assessor
Allocation
Randomized
Enrollment
72 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
QLB group
Arm Type
Experimental
Arm Description
At the end of surgery, before emergence of anesthesia, participants will receive bilateral QLB and intravenous (IV) ketoprofen 100 mg. Ketoprofen 100 mg IV will be repeated every 12 hours. For breakthrough pain patients will receive an IV bolus of morphine 5 mg. IV bolus can be repeated after 20 min. The maximum is 8 boluses for 4 hours.
Arm Title
Control group
Arm Type
No Intervention
Arm Description
At the end of surgery, before emergence of anesthesia, participants will receive IV ketoprofen 100 mg. Ketoprofen 100 mg IV will be repeated every 12 hours. For breakthrough pain patients will receive an IV bolus of morphine 5 mg. IV bolus can be repeated after 20 min. The maximum is 8 boluses for 4 hours.
Intervention Type
Procedure
Intervention Name(s)
QLB
Intervention Description
QLB is ultrasound-guided injection of 30 ml bupivacaine 0.25% into quadratus lumborum plane posterior to the end of internal oblique muscle.
Primary Outcome Measure Information:
Title
Morphine consumption (mg) during the first 12 postoperative hours
Description
Total dose of IV morphine that participants received during the first 12 hours after surgery
Time Frame
12 hours after the end of surgery
Secondary Outcome Measure Information:
Title
Pain at rest
Description
Pain at rest at NRS (Numeric rating scale score 0-10)
Time Frame
2, 6, 12, and 24 hours after surgery
Title
Pain at mobilization
Description
Pain at mobilization at NRS (Numeric rating scale score 0-10)
Time Frame
2, 6, 12, and 24 hours after surgery
Title
Cumulated morphine consumption (mg) at 24 hours postoperatively
Description
Total dose of IV morphine that participants received during the first 24 hours after surgery
Time Frame
24 hours after the end of surgery
Title
Time to first morphine demand
Description
Time to first request for rescue analgesia (morphine) after the end of surgery
Time Frame
24 hours after surgery
Other Pre-specified Outcome Measures:
Title
Postoperative nausea and vomiting (PONV)
Description
Recording PONV (Yes / No)
Time Frame
24 hours after surgery

10. Eligibility

Sex
Female
Gender Based
Yes
Gender Eligibility Description
Participants undergo total abdominal hysterectomy.
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: endometrial carcinoma or uterine fibroids American society of anesthesiologists (ASA) physical status 1-3, Participant's body weight > 50 kg, Written informed consent signed. Exclusion Criteria: Patient's refusal Allergies to any study medication Local skin infection on the site of QLB injection 3. Body mass index > 40 kg/m2 4. Inability to comprehend or participate in scoring scales 4. Deformations that could possibly affect the spread of the local anesthetic in the quadratus lumborum muscle plane 5. Quadratus lumborum muscle plane not seen in ultrasound examination 6. Patients on regular use of opioids 7. Psychiatric disorders
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Nada Pejcic, M.D.
Phone
+381604104123
Email
nada.pejcic@gmail.com
First Name & Middle Initial & Last Name or Official Title & Degree
Marija Kutlesic, M.D., PhD
Phone
+381642302324
Email
mkutlesic5@gmail.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nada Pejcic, M.D.
Organizational Affiliation
Leskovac General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
CCNis
City
Nis
ZIP/Postal Code
18000
Country
Serbia
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Marija Kutlesic, M.D.
Phone
+381642302324
Email
mkutlesic5@gmail.com
First Name & Middle Initial & Last Name & Degree
Nada Pejcic, M.D.

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Qualified researchers engaging in independent scientific research could request data via email address: nada.pejcic@gmail.com
IPD Sharing Time Frame
Data requests can be submitted starting 9 months after article publication and the data will be made accessible for up to 24 months. Extensions will be considered on a case-by-case basis.
IPD Sharing Access Criteria
Access to trial IPD can be requested by qualified researchers engaging in independent scientific research, and will be provided following review and approval of a research proposal and Statistical Analysis Plan (SAP) and execution of a Data Sharing Agreement (DSA). For more information or to submit a request, please contact nada.pejcic@gmail.com
Citations:
PubMed Identifier
30914471
Citation
Lirk P, Thiry J, Bonnet MP, Joshi GP, Bonnet F; PROSPECT Working Group. Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations. Reg Anesth Pain Med. 2019 Apr;44(4):425-436. doi: 10.1136/rapm-2018-100024. Epub 2019 Feb 3.
Results Reference
background
PubMed Identifier
33370462
Citation
Roofthooft E, Joshi GP, Rawal N, Van de Velde M; PROSPECT Working Group* of the European Society of Regional Anaesthesia and Pain Therapy and supported by the Obstetric Anaesthetists' Association. PROSPECT guideline for elective caesarean section: updated systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2021 May;76(5):665-680. doi: 10.1111/anae.15339. Epub 2020 Dec 28.
Results Reference
background
PubMed Identifier
33177330
Citation
Bollag L, Lim G, Sultan P, Habib AS, Landau R, Zakowski M, Tiouririne M, Bhambhani S, Carvalho B. Society for Obstetric Anesthesia and Perinatology: Consensus Statement and Recommendations for Enhanced Recovery After Cesarean. Anesth Analg. 2021 May 1;132(5):1362-1377. doi: 10.1213/ANE.0000000000005257.
Results Reference
background
PubMed Identifier
29536008
Citation
Akerman M, Pejcic N, Velickovic I. A Review of the Quadratus Lumborum Block and ERAS. Front Med (Lausanne). 2018 Feb 26;5:44. doi: 10.3389/fmed.2018.00044. eCollection 2018.
Results Reference
background
PubMed Identifier
26225500
Citation
Blanco R, Ansari T, Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: A randomised controlled trial. Eur J Anaesthesiol. 2015 Nov;32(11):812-8. doi: 10.1097/EJA.0000000000000299.
Results Reference
result
PubMed Identifier
33082286
Citation
Hansen C, Dam M, Nielsen MV, Tanggaard KB, Poulsen TD, Bendtsen TF, Borglum J. Transmuscular quadratus lumborum block for total laparoscopic hysterectomy: a double-blind, randomized, placebo-controlled trial. Reg Anesth Pain Med. 2021 Jan;46(1):25-30. doi: 10.1136/rapm-2020-101931. Epub 2020 Oct 20.
Results Reference
result

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Quadratus Lumborum Block for Total Abdominal Hysterectomy

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