17 cases will be subjected to bilateral Ultrasound-guided Quadratus lumborum block through bilateral catheter insertion for perioperative analgesia.

17 cases will be subjected to epidural catheter insertion for perioperative analgesia (as a control group).

Pain, Postoperative

Ultrasound guided transmuscular approach for quadratus lumborum block using an 18 gauge Touhy's epidural needle to insert the catheter. Normal saline 5 mL will be used to identify that plane. A volume of 20 ml of 0.25% of Bupivacaine bolus will be injected in that plane just over QL. This will be followed by epidural catheter insertion to facilitate continuous infusion. A similar procedure will be performed on the other side. A continuous infusion of 0.2% Bupivacaine at 5 ml/h will be administered to the patient.
This transmuscular quadratus lumborum (TQL) block, has been suggested to be a simple and perhaps safer alternative to the anterior approach as was described for the original QL block

Quadratus Lumborum Block Using Bupivacaine 0.2%

With Patients placed in sitting position, puncture site will be identified at (T8-9, T9-10, or T10-11) intervertebral spaces. Using aseptic conditions, an 18G Tuohy epidural needle will be used to insert epidural catheter as appropriate.
Induction of epidural analgesia with 10-15 ml bupivacaine 0.25% preoperatively with top up doses of 5-7 ml bupivacaine 0.25% or equivalent administered judiciously till we achieve analgesic level of T4 to L1. The calculated top up doses will be administered each hour using bupivacaine 0.25% or by using a continuous infusion syringe pump for equivalent doses

Epidural Analgesia Using Bupivacaine 0.25%

National Cancer Institute - Cairo University

Perioperative Analgesic Efficiency of Quadratus Lumborum Block vs Epidural in Radical Cystectomy

Perioperative Analgesic Efficiency of Ultrasound Guided Quadratus Lumborum Block Versus Epidural Analgesia in Bladder Cancer Patients Undergoing Radical Cystectomy

The primary outcome measures visual analogue pain scores in the two groups at the end of surgery

The primary outcome measures visual analogue pain scores in the two groups 6 hours postoperatively

The primary outcome measures visual analogue pain scores in the two groups 24 hours postoperatively

The primary outcome measures visual analogue pain scores in the two groups 48 hours postoperatively

Postoperative Nausea and Vomiting using nausea score (0 for none, 1 for mild to moderate nausea, 2 for moderate nausea, 3 for severe nausea accompanied by vomiting) When patient's nausea score reaches ≥ 2; intravenous anti-emetics in the form of Ondasetron 8mg and will be administered and recorded in all groups

During pain assessment using visual analogue score, if VAS score is ≥ 4, intravenous morphine 3mg will be administered 18. The mean first time for morphine requirement will be recorded in all groups (mean+- SD). Total 48 h morphine consumption will be recorded in all groups

Patient satisfaction with the technique and analgesia to be assessed at the end of study (at 48 hours period) and will be put on a scale from 1 to 4 (poor = 1, fair = 2, good = 3, excellent = 4)

National Cancer Institute, Egypt

Group (A): 17 cases will be subjected to bilateral Ultrasound-guided Quadratus lumborum block through bilateral catheter insertion for perioperative analgesia.
Group (B): 17 cases will be subjected to epidural catheter insertion for perioperative analgesia (as a control group).
This number is to be increased to 34 patients (17 patients in each group) to account for the necessity to use non-parametric test. Sample size was calculated using G*Power program (University of Düsseldorf, Düsseldorf, Germany) 17, 20, 21.

Patients had 0.5 ml.kg-1 bupivacaine 0.25% caudally, the maximum given volume was 20 ml. N=42

Patients had 0.5 ml.kg-1 bupivacaine 0.25% with the addition of 3 mg/kg lidocaine 1% caudally, the maximum given volume was 20 ml. N=44

Anesthesia, Local

0.5 ml.kg-1 bupivacaine 0.25%

0.5 ml.kg-1 bupivacaine 0.25% with the addition of 3 mg/kg lidocaine 1%

Brennan J. Modern day-case anaesthesia for children. Br J Anaesth. 1999;83:91-103.

Suresh S et al. Are Caudal Blocks for Pain Control Safe in Children? An Analysis of 18,650 Caudal Blocks from the Pediatric Regional Anesthesia Network (PRAN) Database. Anesth Analgesia. 2015;120:151-156

Nancy B et al. Regional anesth and Pain Management for the Pediatric Patient. ınternatıonal anesthesıology clınıcs:2012; 50,4,83-95

Corliss A, Alyssa A, Timothy J, Danielle A Hamilton. Buffered lidocaine and bupivacaine mixture - the ideal local anesthetic solution? Plast Surg 2015: 23; 2, 87-90

Ayancık State Hospital

Analgesic Efficacy of Lidocaine Plus Bupivacaine Versus Bupivacaine Alone Caudally

The Efficacy of Bupivacaine Alone and in Combination With Lidocaine at Performing Caudal Block on Analgesia in Pediatric Patients Underwent Circumcision: A Historical Cohort Study

Pain scores were typically recorded on a scale from 0 to 10 by visual analogue scale (VAS), whereas, in children younger than 4 years the FLACC (Face, Legs, Activity, Cry, Consolability) score was used.

An intra-operative decrease in blood pressure(BP) or heart rate(HR) of more than 20% from preoperative values was defined as hypotension or bradycardia, respectively, and was treated with rapid infusion of fluids or with atropine 0.01 mg/kg.

An intraoperative increase in BP or HR by more than 20% was defined as insufficient analgesia and was treated with fentanyl 1 mcg/kg iv.

Ayse Gulsah Atasever

Resident Anesthesiologist

Phase III group-based cardiac rehabilitation classes, weekly

Normal daily living, no extra visits to study centre

Microvascular Angina

Phase III group-based cardiac rehabilitation

visceral pain/atròfia

Perioperative Analgesic Efficiency of Quadratus Lumborum Block vs Epidural in Radical Cystectomy

Analgesic Efficacy of Lidocaine Plus Bupivacaine Versus Bupivacaine Alone Caudally

The Impact of Cardiac Rehabilitation Participation on Cardiac Syndrome X

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