Application of Anterior Quadratus Lumborum Block at the Lateral Supra-arcuate Ligament Under Laparoscopic Direct Vision in Laparoscopic Renal Surgery
Application of Anterior Quadratus Lumborum Block at the Lateral Supra-arcuate Ligament Under Laparoscopic Direct Vision in Laparoscopic Renal Surgery：A Randomized, Controlled Trial
Second Affiliated Hospital, School of Medicine, Zhejiang University
66 participants
Aug 14, 2024
INTERVENTIONAL
Conditions
Summary
Evaluation of the effectiveness of Anterior Quadratus Lumborum Block at the lateral supra-arcuate ligament under laparoscopic direct vision compared to local infiltration anesthesia for postoperative analgesia after laparoscopic renal surgery in patients.A randomized controlled trial involving 66 patients undergoing laparoscopic renal surgery will assign them randomly to an experimental group or a control group.The patients in experimental group will receive Anterior Quadratus Lumborum Block at the lateral supra-arcuate ligament under laparoscopic direct vision.The patients in control group will receive local infiltration anesthesia.The primary outcome measure is the cumulative consumption of intravenous morphine equivalents at postoperative 24 hours.The secondary outcomes include the cumulative consumption of intravenous morphine equivalents at postoperative 2, 4, 6, 12 and 48 hours, Numeric Rating Scale(NRS) score at rest and during activity (coughing) at postoperative 2, 6, 24 and 48 hours, Global Comfort Questionnaire(GCQ) Comfort Status Scale Score, Quality of Recovery-15(QoR-15) Postoperative Recovery Scale Score, time of the first press on the Patient-Controlled Analgesia pump, nausea, vomiting, skin itching, drowsiness, or other adverse reactions, regional anesthesia-related complications such as local anesthetic toxicity and length of postoperative hospital stay after surgery.
Eligibility
Inclusion Criteria3
- Age: 18 to 80 years old;
- American Society of Anesthesiologists (ASA) physical status classification: I to III;
- Undergoing laparoscopic nephrectomy or partial nephrectomy (including robotic-assisted laparoscopic nephrectomy and partial nephrectomy).
Exclusion Criteria9
- Recent use of anticoagulant medications or abnormal coagulation function;
- Local infection at the puncture site or the presence of tumors, severe deformities, or systemic infection;
- Severe renal failure (serum creatinine \> 442 μmol/L or requiring renal replacement therapy) or liver dysfunction (Child-Pugh Class C);
- Known allergy to local anesthetics or a family history of local anesthetic allergy;
- Preoperative cognitive impairment or inability to assess pain;
- Alcoholism, drug abuse, chronic opioid dependence, or the use of analgesics or psychotropic medications for more than 3 months;
- History of central and/or peripheral nervous system disorders or myasthenia gravis;
- Planned admission to the ICU;
- Surgical cancellation or patient refusal, etc.
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Interventions
The urologists find the inner arcuate ligament. The scalp needle is inserted from the midpoint of the lower edge of the inner or outer arcuate ligament towards the head to the dorsal side of the diaphragm. After withdrawing without blood, air, or cerebrospinal fluid, 2 ml of normal saline is first administered to observe the fluid spreading towards the head Then, 20 ml of 0.375% ropivacaine hydrochloride injection is administered.
The urologists give local infiltration anesthesia with 20 ml of 0.375% ropivacaine hydrochloride injection.
Locations(1)
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NCT06550869