Postoperative Pain
Conditions
Brief summary
The purpose of this study is to compare between two surgical techniques for anterior abdominal wall blocks in obese patients Undergoing Major Gynecological Surgery: Surgical Transversus Abdominis Plane \[TAP\] block versus Rectus Sheath block as regards the efficacy and adverse effects
Interventions
PROCEDURESurgical Transversus Abdominis Plane Block
At the end of operation and after hemostasis, 20 ml of 0.25% bupivacaine will be injected intra-abdominally into the Transversus Abdominis plane at the midpoint of the line connecting the crista iliaca and inferior costal margin and at two locations in the lateral abdominal wall at 3-4 cm inferior to the previous midline injection. The same procedure will be repeated on the opposite side using an identical amount of local anesthetic.
PROCEDURESurgical Rectus Sheath Block
At the end of operation and after hemostasis,20 ml 0.25% bupivacaine will be administered slowly under direct vision after careful aspiration to the rectus sheath space which is present inbetween rectus abdominis muscle and the posterior layer of its sheath at the upper pole of the midline incision by time of closure of the anterior abdominal wall. The procedure will be repeated on the opposite side.
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* female patients * undergoing major gynecological surgery with supraumbilical midline incision the first time * Body mass index (BMI) more than 40.
Exclusion criteria
* patient refusal to participate in the study, * reoperation, * addiction * alcohol abuse * hypersensitivity or allergy to the study drugs
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Total dose of morphine consumption | First 24 hours postoperatively |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Numerical rate scale | First 24 hours postoperatively | Postoperative pain will be assessed at rest and coughing using numerical rate scale (NRS) patients are asked to rate their pain on a scale from 0 to 10, where 0 represents no pain and 10 represents the worst pain possible,. |
| Postoperative respiratory functions | First 24 hours postoperatively | will be measured using incentive spirometer. Patients were asked to do sustained maximal inspiration (SMI) three times. Then average SMI will be recorded. They will be instructed prior to induction of general anesthesia about the usage of incentive spirometer then a basal measurement will be obtained. After recovery, measurement will be obtained on 60 min, 6 hours, 12 hrs and 24 hrs. |
Countries
Egypt
Outcome results
None listed