Postoperative Pain
Conditions
Brief summary
Comparing the impact of bilateral erector spinae plane block and transverse abdominis plane block on improving quality of pain management after umbilical hernia repair.
Detailed description
Postoperative pain is an important problem after umbilical hernia repair which has negative effects on patient's hemodynamics and cause delayed ambulation resulting in prolonged duration of hospital stay and poor patient satisfaction. Multiple analgesic strategies have been proposed including Non steroidal anti-inflammatory drugs (NSAIDs), opioids, epidural analgesia. Each of them has its limitations. Ultra¬sound guided regional anesthesia techniques for abdominal wall can be effective components of multimodal postoperative analgesia with limited side-effects Erector spinae plane (ESP) block is a promising para-spinal bock that can achieve both visceral and somatic abdominal analgesia if the injection was performed at a lower thoracic level. Transverse abdominis plane (TAP) block which is considered a peripheral nerve block that is aimed at anesthetizing nerves supplying the anterior abdominal wall. We will compare between erector spinae plane block and transverse abdominis plane block for controlling postoperative pain after umbilical hernia repair. Patients will be allocated randomly into two equal groups by a computer-generated randomization table Group (E) (n=26): Patients will receive erector spinae plane (ESP) block after completion of surgery. Group (T) (n= 26): Patients will receive oblique subcostal transverse abdominis plane (TAP) block after completion of surgery
Interventions
PROCEDUREerector spinae plane (ESP) block
Using the in plane technique, the needle will be advanced between the transverse process and erector spinae muscle. The correct location will be confirmed using 1ml of Local Anesthetic (LA) to view hydrodissection(12). 19ml of LA will be injected between the muscle and transverse process.
PROCEDUREoblique subcostal transverse abdominis plane (TAP) block
An echogenic needle will be inserted in-plane until the needle tip reaches the fascia between the rectus abdominis and the transverse abdominis muscles. Once the needle enters the TAP plane, a dynamic injection can be performed by advancing the needle under ultrasound guidance laterally in the pocket created by the initial injection of 5 - 10 mL of local anesthetic; as the needle is advanced, the remaining local anesthetic will be injected. This allows for a more lateral spread of the local anesthetic
Sponsors
Zagazig University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 60 Years
Healthy volunteers
Yes
Inclusion criteria
* Patients scheduled for elective umbilical hernia repair. * Patient acceptance. * Both sex * Patient's age 21 - 60 years. * Patients with American Society of Anesthesiologists (ASA) physical status I, II. * BMI 25 - 30 kg m-2.
Exclusion criteria
* Uncooperative patients and patients with psychological problems. * Patients with liver or renal impairment. * Patients with contraindication to regional anesthesia. * Patients with history of allergy to drug used in the study. * Patients with chronic pain.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative analgesic requirements | 24 hours postoperative | measuring the total doses of analgesic required to relieve the pain |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain severity using Verbal Rating Scale | 24 hours postoperative | assessing pain severity using Verbal Rating Scale (mild, moderate and severe) |
| Postoperative pain severity using Numeric Rating Scale | 24 hours postoperative | assessing pain severity using Numeric Rating Scale (NRS) (0-10; 0, no pain; 10, worst pain) |
| Postoperative heart rate changes | 24 hours postoperative | monitoring postoperative changes in the heart rate (HR) measured by beat per minute (BPM) and comparing it with the preoperative measures |
| Postoperative pain severity using Visual Analogue scale | 24 hours postoperative | assessing pain severity using Visual Analogue scale (VAS) (0-100mm) |
| Incidence of postoperative side effects | 24 hours postoperative | recording any postoperative complications as nausea and vomiting |
| Duration of postoperative hospital stay | 24 hours postoperative | measuring the delay in discharging the patients postoperative because of the pain |
| Postoperative blood pressure changes | 24 hours postoperative | monitoring postoperative changes in the blood pressure (BP) measured by mm Hg and comparing it with the preoperative measures. |
Countries
Egypt
Contacts
Primary Contactmichael A shaker, lecturer
Backup Contactsalwa s ElSherbeny, lecturer
Outcome results
None listed