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IMPROVING POSTOPERATIVE PAIN MANAGEMENT AFTER HAND-ASSISTED LAPAROSCOPIC NEPHRECTOMY FOR KIDNEY-CANCER WITH THE ULTRASOUND-GUIDED TRANSMUSCULAR QUADRATUS LUMBORUM (TQL) BLOCK -A RANDOMIZED CONTROLLED TRIAL
Author(s): ,
Dam, M.*
Affiliations:
Zealand university hospital -Roskilde- Copenhagen university, Anaesthesiology and intensive care, Roskilde, Denmark
,
Hansen, C.K.
Affiliations:
Zealand university hospital -Roskilde- Copenhagen university, Anaesthesiology and intensive care, Roskilde, Denmark
,
Poulsen, T.D.
Affiliations:
Zealand university hospital -Roskilde- Copenhagen university, Anaesthesiology and intensive care, Roskilde, Denmark
,
Azawi, N.
Affiliations:
Zealand university hospital -Roskilde- Copenhagen university, Urology, Roskilde, Denmark
,
Bendtsen, T.F.
Affiliations:
Aarhus University Hospital, Anaesthesiology & Intensive Care Medicine-, Aarhus, Denmark
Børglum, J.
Affiliations:
Zealand university hospital -Roskilde- Copenhagen university, Anaesthesiology and intensive care, Roskilde, Denmark
ESRA Academy. Dam M. Sep 13, 2017; 190981; 352 Topic: Trunk Blocks
Dr. Mette Dam
Dr. Mette Dam

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Abstract
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Background and Aims:

Kidney-cancer patients often undergo hand-assisted laparoscopic nephrectomy. Our one-year retrospective study revealed that 67% of the patients needed substantial amounts of opioids for sufficient postoperative pain management in recovery despite a multimodal analgesic regime; i.e. 22.1±13.5 mg morphine (mean±SD). In a prospective pilot study including ten kidney-cancer patients undergoing laparoscopic hand-assisted nephrectomy presenting with severe postoperative pain (NRS > 6) in recovery, we found that bilateral USG TQL block substantially reduced pain and opioid consumption. This study aims to compare the efficacy of  bilateral USG TQL block in reducing postoperative opioid consumption compared to placebo.

Methods:

A single center, randomized, controlled and double-blinded trial with concealed allocation achieved ethics committee approval. Sixty patients undergoing hand-assisted laparoscopic nephrectomy under standardized general anesthesia with a multimodal analgesic regime will be randomized to receive either bilateral preoperative USG TQL block with 30+30 ml Ropivacaine 0.375% or isotonic saline. Primary outcome: Accumulated opioid consumption during the first 12 postoperative hours. Secondary outcomes: NRS (0-10) pain scores, total morphine consumption, time to first opioid, adverse effects, satisfaction with treatment, time to ambulation. We will be able to detect a 50% reduction in recorded opioid consumption with α=5%, β=20% and a dropout rate of 15%.

Results:

Preliminary results, block tecknique and study design from our ongoing randomized trial will be presented.

Conclusions:

The present study is powered to demonstrate whether a bilateral USG TQL block can reduce opioid consumption with clinical significance for kidney-cancer patients undergoing hand-assisted laparoscopic nephrectomy

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