Erector Spinae Block, Bariatric Surgery Candidate
Conditions
Brief summary
The purpose of this study to compare erector spinae block to transversus abdominis plane block in bariatric surgeries regarding analgesic efficacy and postoperative oxygenation and respiratory complications
Detailed description
The erector spinae plane (ESP) block is an interfascial block proposed to provide analgesia for chronic pain and perioperative period. it can provide both visceral and somatic abdominal analgesia if the injection were performed at a lower thoracic level. ESP block is effective, easy to perform, and can be performed in a short time. Therefore, bilateral ESP block may have comparable or improved analgesic effect in upper and lower abdominal surgical procedures when compared to other suitable plane blocks. Transversus abdominis plane (TAP) block technique is to reduce postoperative pain and is a part of current analgesic regimen for many abdominal surgeries . Moreover, it was found that posterior TAP block appears to produce more prolonged analgesia than the lateral TAP block. Ultrasound guided TAP block is a feasible, minimally invasive technique . It reduces the postoperative requirement of opioid analgesics, decreases the incidence and severity of postoperative nausea and vomiting, improves patient satisfaction, and allows early readiness for discharge postoperatively. Both blocks is effective in reducing postoperative complication and need of analgesia , To our knowledge there is no comparative study between the two blocks to this population . the investigators aim to compare the perioperative analgesic effect between TAP block and ES block in bariatric .
Interventions
PROCEDUREtransversus abdominis block
transversus abdominis block
PROCEDUREErector spinae block
Erector spinae block
Local Anesthetic used in both blocks
DEVICESiemens Acuson x300 3-5MHz Ultrasound
Ultrasound used to aid in the blocks
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Patient age \>18 \<60 * Obese patients ; Body mass index(BMI) 40-50 kg/m2 * Both sexes * American Society of Anesthesiologists(ASA) physical status classes II and III * Patients scheduled for laparoscopic bariatric surgery i.e. sleeve gastrectomy and/or Roux-en-Y gastric bypass (RYGB)surgeries
Exclusion criteria
* Refusal of regional block * Patients with neurological, psychological disorders or those lacking cooperation * Patients scheduled for concomitant laparoscopic cholecystectomy or paraumbilical hernia repair or those with history of previous bariatric surgery or obstructive sleep apnea * Patients with anatomic abnormalities at site of injection, skin lesions or wounds at site of proposed needle insertion. * Patients with bleeding disorders defined as (INR \>2) and/ or (platelet count \<100,000/µL) * Patients with hepatic disease e.g. liver cell failure or hepatic malignancy or hepatic enlargement. * Patients who are allergic to amide local anesthetics. * Cases converted to open surgery will also be excluded from the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| efficacy of block | first 24 hours postoperative | The analgesic efficacy of erector spinae block versus TAP block assessed by visual analogue score(range from 1 denoted the least pain to 10 as the worst pain) in 24hr in laparoscopic bariatric surgery. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| failure rate | first hour postoperatively | Failure rate in both groups |
Other
| Measure | Time frame | Description |
|---|---|---|
| feasibility of block | preoperative | Time taken to perform a successful block |
| ambulation | 24 hour | Time to ambulate in both groups |
| arterial oxygen tension to fraction of inspired oxygen ratio | 12, 24 hours postoperative | p/f ratio after first 12 , 24 hours postoperatively in both groups |
| pulmonary complications | 12,24 hours postoperative | Incidence of postoperative pulmonary complication ( chest x-ray at 12, 24 hr postoperative ) |
Countries
Egypt
Outcome results
None listed