Postoperative Pain
Conditions
Keywords
erector spinae plane block, total abdominal hysterectomy, dexamethasone
Brief summary
The aim to study the efficacy of bupivacaine 0.25% with dexamethasone and that of bupivacaine 0.25% alone for erector spinae plane block for postoperative analgesia in patients undergoing total abdominal hysterectomy Group 1: bupivacaine 0.25% + dexamethasone 8 mg * Group 2: bupivacaine 0.25% * Group3: control group A prospective Randomized Interventional double-blind study.
Detailed description
Optimal dynamic analgesia is recognized as the key to enhanced recovery following open abdominal surgery. In the last decade, there has been a significant shift away from thoracic epidural analgesia (TEA) that has been long considered as the gold standard. Various techniques have tried to replicate the analgesic efficacy of TEA. They include transversus abdominis plane analgesia (TAP), rectus sheath analgesia (RS), wound infusion analgesia (WI) and trans muscular quadratus lumborum analgesia. However, each of these techniques has specific limitations that prevent them from being the analgesic technique of choice for all open abdominal surgeries. Chin et al first described the erector spinae plane (ESP) block for providing analgesia following ventral hernia repair. The unique feature of the ultrasound-guided truncal blocks is that in all of these techniques, in contrast to peripheral nerve blocks, no nerve or plexus needs to be identified: Local anesthesia (LA) is injected in a particular muscle plane, in which the injectate spreads and reaches the intended nerves. This simple mechanism has made delivery of nerve blocks easy and versatile.
Interventions
DRUGbupivacaine
Bilateral TAP block with 20 ml of 0.25% bupivacaine
DRUGdexamethasone
Bilateral TAP block with 4 mg/kg dexamethasone diluted with isotonic saline.
Bilateral TAP block with placebo to dexamethasone.
DRUGplacebo to bupivacaine
Bilateral TAP block with placebo to bupivacaine.
Sponsors
Aswan University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
Participating patients, surgeons, anesthesiologists and medical investigators who will be involved in the data collection will be all blinded to the patient's group assignment until the collection of data for all cases will be complete for group 1 and 2.
Intervention model description
A prospective Randomized Interventional double-blind study.
Eligibility
Sex/Gender
FEMALE
Age
30 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Women ranging age between 30-60 years a who undergoing elective total abdominal hysterectomy
Exclusion criteria
* Participants had known sensitivity to bupivacaine * Participants had difficulty in intubation * Participants were on chronic pain medication or already on long-term opioids * Participants smokers * Participants with disabilities who were unable to communicate pain levels * refuse to consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Visual analog score for pain during movement | 24 hours post operative | movement-evoked pain measurements ranging from 0 to 10, where 0 no pain and 10 maximum pain |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| number of days patients stay in hospital | 4 weeks | calculation of number of days patients stay in hospital |
| Visual analog score for pain during rest | 24 hours postoperative | ranging from 0 to 10, where 0 no pain and 10 maximum pain |
| number of patients need Fentanyl consumption | 24 hours postoperative | calculation of the number of patients need Fentanyl consumption |
Countries
Egypt
Outcome results
None listed