Thoracic Sympathectomy
Conditions
Brief summary
* Thoracic incisions are painful and associated with chronic post-surgical pain and inadequate analgesia is associated with poorer postoperative outcomes. Recent progress has been made in the field of thoracic anesthesia by improving analgesic modalities such as PECS 1 and PECS 2, intercostal plane block, paravertebral regional anesthesia, ultrasound-guided erector spinae and serratus anterior plane block. * Administered of the local anesthetic in erector spinae plane block is in the interfascial plane between the transverse process of the vertebra and the erector spinae muscles, spreading to multiple paravertebral spaces. It affects both the ventral and dorsal rami and leading to blockage of both visceral and somatic pain. * Ultrasound-guided serratus anterior plane block is a facial plane block that provides analgesia by blocking of lateral branches of intercostal nerves above or below the serratus plane muscle. * We hypothesize that the ultrasound-guided erector spinae plane block may have better quality than the serratus anterior plane block for patients undergoing thoracoscopic sympathectomy as erector spinea plane blocks visceral and somatic pain.
Detailed description
Primary palmar hyperhidrosis (PPH) refers to the excessive secretion of exocrine glands on the palms, which is often accompanied by the head, face, or plantar hyperhidrosis. PPH demonstrates no obvious organic cause; however, some patients may feel distressed because their palms sweat more than normal, and such a situation may lead to severe psychological, social, and occupational dysfunction. Endoscopic thoracic sympathectomy abolishes eccrine sweating in all areas supplied by the postganglionic fibers with its complications which include post-sympathetic neuralgia which is the most important, wound infection, hemorrhage, pneumothorax, horner syndrome, no response to the operation and compensatory hyperhidrosis in non-denervated areas. Forero described ultrasound-guided erector spinae plane block for treatment of thoracic neuropathic pain and explained it as a peri-paravertebral regional anesthesia technique that has been used for prevention of postoperative pain in various surgeries. Ultrasound-guided serratus anterior plane block is a facial plane block which provides analgesia by blocking of lateral branches of intercostal nerves above or below the serratus plane muscle. There are few cases and studies in the literature reporting successful analgesia provided by serratus anterior plane block
Interventions
PROCEDUREErector spinae plane block
Erector Spinae Group (Group E) will receive bilateral ultrasound-guided erector spinae plane block using 30 ml hyperbaric bupivacaine 0.25% will be injected between erector spinae muscle and transverse process of T4
PROCEDURESerratus anterior plane block
Serratus anterior Group (Group S) will undergo bilateral ultrasound-guided serratus anterior plane block with 30 ml hyperbaric bupivacaine 0.25% will be injected above or below serratus anterior muscle at the level of 4th and 5th rib on the midaxillary line
Sponsors
Mansoura University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Subject)
Masking description
Single-blind (participant) study
Eligibility
Sex/Gender
ALL
Age
21 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists grade I or II physical status
Exclusion criteria
* Patients who had coagulopathies * local infections * neuropathies * neuromuscular disease * psychiatric disease * history of thoracic surgery * history of allergy to local anesthetics. * receiving chronic analgesic therapy * drug abusers
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The total analgesic consumption | 1st 24 hours after surgery | cumulative consumption of opioids during the first postoperative day |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| systolic blood pressure | Intraoperative (every 10 minutes till the end of surgery) | changes in systolic blood pressure |
| Postoperative severity of the pain | every 2 hours for 12hours and then at 16, 20 and 24 hours postoperatively | Visual analogue scale (0-100),where 0 point is equal to no pain and 100 indicate the worst possible pain |
| The total amount of fentanyl consumption | 1st 24 hours after surgery | cumulative consumption of fentanyl during the first postoperative day |
| The total amount of paracetamol consumption | 1st 24 hours after surgery | cumulative consumption of paracetamol during the first post operative day |
| Duration of analgesia | within 24 hours after surgery | from the end of block till the time for the first analgesic requirement (ketorolac) |
| Nausea | 1st 24 hours after surgery | number of patients with nausea |
| End-tidal carbon dioxide tension | Intraoperative (every 10 minutes till the end of surgery) | changes in end-tidal carbon dioxide tension as measured with capnography |
| Patient Satisfaction | After 12 and 24 hours after surgery | evaluated as 5:excellent, 4:very good, 3:good, 2: fair, 1:poor |
| Heart rate | Intraoperative (every 10 minutes till the end of surgery) | changes in heart rate |
| Peripheral oxygen saturation | Intraoperative (every 10 minutes till the end of surgery) | changes in Peripheral oxygen saturation as measured with pulse oximetry |
| diastolic blood pressures | Intraoperative (every 10 minutes till the end of surgery) | changes in diastolic blood pressure |
| mean blood pressures | Intraoperative (every 10 minutes till the end of surgery) | changes in mean arterial blood pressure |
| Vomiting | 1st 24 hours after surgery | number of patients with vomiting |
Countries
Egypt
Contacts
Primary ContactMohamed Y Makharita, MD
Backup ContactDoaa G Diab, MD
Outcome results
None listed