| INTERVENTIONS |
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Intervention type
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Intervention name
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Dose
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Duration
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Intervention description
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Group size
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Nature of control
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| Experimental Group |
QL2 group |
0.25% levobupivacaine 30 mL on each side |
48 hours |
QLB will be performed with atraumatic needle (22-G, 120-mm needle for peripheral nerve blocks, B. Braun Melsungen AG, Germany) advanced in-plane under the guidance of an ultrasound machine (X-Porte, Sonosite Ltd, USA) with a convex probe (2–5 MHz). With the patient in the supine position. The ultrasonogram of the abdominal wall could be displayed clearly through probe moving or tilting after the skin preparation with 2% chlorhexidine. Pillows could help to relieve the tension along the abdominal wall of patients. The whole procedure will be performed strictly according to clinical protocol. In this study, QL2 will be conducted through an anterolateral approach with the supine position as mentioned earlier. The ultrasound transducer will be placed transversely on both flanks at the horizontal level of L2-3 and will be adjusted until the “Shamrock sign” formed of QL muscle, psoas major and erector spinae will be visualized, with imaging depth set between 0 and 9.9 cm .Needles will penetrate in an anterolateral to posteromedial direction. Local anesthetic will be injected posterior to QL muscle in QL2, . The solution will be injected after negative aspiration to exclude vascular puncture |
20 |
|
| Experimental Group |
QLB 3 |
0.25% levobupivacaine (AstraZeneca, Södertälje, Sweden) at 30 mL at the sites |
48 hours |
QLB will be performed with atraumatic needle (22-G, 120-mm needle for peripheral nerve blocks, B. Braun Melsungen AG, Germany) advanced in-plane under the guidance of an ultrasound machine (X-Porte, Sonosite Ltd, USA) with a convex probe (2–5 MHz). With the patient in the supine position. The ultrasonogram of the abdominal wall could be displayed clearly through probe moving or tilting after the skin preparation with 2% chlorhexidine. Pillows could help to relieve the tension along the abdominal wall of patients. The whole procedure will be performed strictly according to clinical protocol. In this study, QL3 will be conducted through an anterolateral approach with the supine position as mentioned earlier. The ultrasound transducer will be placed transversely on both flanks at the horizontal level of L2-3 and will be adjusted until the “Shamrock sign” formed of QL muscle, psoas major and erector spinae will be visualized, with imaging depth set between 0 and 9.9 cm .Needles will penetrate in an anterolateral to posteromedial direction. Local anesthetic will be injected between QL muscle and psoas major.The solution will be injected after negative aspiration to exclude vascular puncture |
20 |
|
| Experimental Group |
combined QLB 2 and 3 |
0.25% levobupivacaine 15 mL at each point of injection with the needle inserting only once in each side
total 30 ml per side |
48 hours |
QLB will be performed with atraumatic needle (22-G, 120-mm needle for peripheral nerve blocks, B. Braun Melsungen AG, Germany) advanced in-plane under the guidance of an ultrasound machine (X-Porte, Sonosite Ltd, USA) with a convex probe (2–5 MHz). With the patient in the supine position. The ultrasonogram of the abdominal wall could be displayed clearly through probe moving or tilting after the skin preparation with 2% chlorhexidine. Pillows could help to relieve the tension along the abdominal wall of patients. The whole procedure will be performed strictly according to clinical protocol. In this study,QL2+3 will be conducted through an anterolateral approach with the supine position as mentioned earlier. The ultrasound transducer will be placed transversely on both flanks at the horizontal level of L2-3 and will be adjusted until the “Shamrock sign” formed of QL muscle, psoas major and erector spinae will be visualized, with imaging depth set between 0 and 9.9 cm .Needles will penetrate in an anterolateral to posteromedial direction. Local anesthetic will be injected posterior to QL muscle in QL2, while in QL3, it will be located between QL muscle and psoas major..QL2+3 blocks could be conducted in the same plane with only one puncture on each side The solution will be injected after negative aspiration to exclude vascular puncture |
20 |
|
| Control Group |
QLB C |
30 ml normal saline in each side |
48 hours |
all patients will be in the supine position, tilting 45 degrees to the opposed side in order to place the low-frequency convex probe properly and see the sonography clearly QLB will be underwent bilateral under ultrasonography guidance withnormal saline 30 mL on each side. Two regional anaesthesiologists experienced in peripheral nerve blocks will perform QLB or provided guidance. QLB will be performed with atraumatic needle (22-G, 120-mm needle for peripheral nerve blocks, B. Braun Melsungen AG, Germany) advanced in-plane under the guidance of an ultrasound machine (X-Porte, Sonosite Ltd, USA) with a convex probe (2–5 MHz). With the patient in the supine position. The ultrasonogram of the abdominal wall could be displayed clearly through probe moving or tilting after the skin preparation with 2% chlorhexidine. Pillows could help to relieve the tension along the abdominal wall of patients. The whole procedure will be performed strictly according to clinical protocol. In this study, QLB C will be conducted through an anterolateral approach with the supine position . The ultrasound transducer will be placed transversely on both flanks at the horizontal level of L2-3 and will be adjusted until the “Shamrock sign” formed of QL muscle, psoas major and erector spinae will be visualized, with imaging depth set between 0 and 9.9 cm .Needles will penetrate in an anterolateral to posteromedial direction. Local anesthetic will be injected posterior to QL muscle |
20 |
Placebo |