At a glance
ClinicalIndex Comparison RecordStandardized by ClinicalIndex from the ClinicalTrials.gov record · verify against the source.
Analgesic Effect of Ultrasound Guided Caudal Block Versus Quadratus Lumborum Plane Block in Lumbar Spine Surgery in Adult Patients: A Double Blinded Prospective Comparative Study
In Brief
A clinical study evaluating Caudal and Quadratus lumborum plane block for Spondylolisthesis and 2 related conditions. Completed, enrolled 111 participants across 1 site.
Detailed Summary
Postoperative pain is a common complication after lumbar spine surgery due to inherent tissue damage during surgical procedures. Many analgesic options have been explored. Opioid analgesics carry the risk of respiratory depression. Nonsteroidal anti-inflammatory drugs (NSAIDs) are popular and widely used as first-line treatment for acute pain following spinal surgery, but can provide inadequate analgesia. High doses of NSAIDs have also been linked to non-unions in spinal fusion surgery. Patient-controlled analgesia or epidural injection analgesia are usually used. One of US guided regional anesthesia methods is the ultrasound-guided caudal block that was first described by Klocke and colleagues in 2003. One of the more recent techniques that has been described recently is quadratus lumborum plane block(QLB),that is posterior abdominal wall fascial plane block first described by Blanco in 2007.In this study we will compare between analgesic effect of ultrasound guided caudal block to that of ultrasound guided quadratus lumborum plane block as well as safety of both modalities in adult patients undergoing lumbar spine fixation surgeries.
Study Details
Timeline
Interventions
In the prone position , linear transducer will be first positioned transversely on the middle line. The two sacral cornua appear as two hyperechoic structures ,two hyperechoic band structures are present between the two sacral cornua. The superficial is the sacrococcygeal ligament (SCL) and the deep is the dorsal surface of the sacrum. The sacral hiatus is a hypoechoic area between two band-like hyperechoic structures. In longitudinal view, the block needle will be inserted using the in plane technique .The block needle can be visualized in real time piercing the SCL entering the hiatus but cannot be visualized beyond the apex of the hiatus. It is therefore proposed to limit the extension of the needle tip beyond the tip of the sacral hiatus to 5 mm to avoid perforating the dura mater. After the needle is inserted in the caudal canal, 20 ml of 0.25% bupivacaine will be injected.
The patient is placed in the prone position , under aseptic conditions with the sterile convex probe is placed in a transverse view at the triangle of the QL muscle and the middle thoracolumbar fascia. The projected needle path is advanced in-plane until the needle tip is visualized between the middle thoracolumbar fascia and the QL muscle . After confirming the location of the needle with 2-3 ml of saline and then aspiration, 20 ml of 0.25% bupivacaine is injected in this plane with confirmation by visualizing hydro dissection . the procedure is applied to the opposite side using the same dose to achieve bilateral block.