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 who did not have any change or a change less than 4 points between MMT1 and MMT3

Patients with a difference more than 4 points between MMT1 and MMT3

Post Operative Cognitive Dysfunction

Mini Mental Test was used for literate patients and Modified mini mental test was used for illiterated patients

Mini Mental and Modified Mini Mental Test

Effect of Preoperative Hospitalization Duration on Post-operative Cognitive Dysfunction

Effect of Preoperative Hospitalization Duration on Post-operative Cognitive Dysfunction in Patients Who Underwent Hip Surgery Under Regional Anesthesia

Burcu Ozalp Horsanali

Burcu OZALP HORSANALI

A single dose of sugammadex 2 mg/kg iv. Dose calculation will be based on the patient's actual body weight. No dose adjustments are allowed

A single dose of neostigmine 0.04 mg/kg iv plus glycopyrrolate 0.01 mg/kg iv. Dose calculation will be based on the patient's actual body weight. No dose adjustments are allowed.

Anesthesia Recovery Period

Sugammadex

A single dose of neostigmine 0.04 mg/kg iv plus glycopyrrolate 0.01 mg/kg iv

bradycardia/nicotine

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

Effect of Preoperative Hospitalization Duration on Post-operative Cognitive Dysfunction

Street Fitness in Surgical Patients Undergoing General Anesthesia After Reversal of Neuromuscular Blockade

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