Post Operative Pain
Conditions
Brief summary
The goal of postoperative pain management is the provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using regional anethesia. This study aimed to assess the analgesic effect of adding dexamethasone or magnesium sulphate with bupivacaine in ultrasound-guided QLB to prolong its duration in patients undergoing open abdominal surgeries in the early postoperative period regarding pain relief After approval of the ethical committees in Ain Shams University Hospitals, patients undergoing open abdominal surgeries were included in the study, and were divided into three groups (n=22; each); group M, D and group C. In Group A, patients (n=22) received 20 ml bupivacaine 0.25% plus 5 ml of 10% MgSO. In group B, patients (n=22) received 20 ml bupivacaine 0.25% plus 8 mg dexamethasone (2 ml) plus 3 ml 0.9% NaCl. In group C (control), patients (n=22) received 20 ml bupivacaine plus 5 ml 0.9% NaCl.
Interventions
DRUGBupivacaine- Magnesium
Patients received QL block with 20 ml of 0.25% bupivacaine (2, 4)plus 5 ml of 10% MgSO4.
DRUGBupivacaine dexamethasone
Patients received QL block with 20 ml of 0.25% bupivacaine (2,4)plus 2 ml of 8 mg dexamethasone plus 3 ml of 0.9% NS.
Patients received QL block with 20 ml of 0.25% bupivacaine (2,4)plus 5 ml of 0.9% NS.
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists (ASA) physical status I or II * aged 18 to 65 years * body weight ≥ 60 kg and ≤ 90 kg * scheduled for open abdominal surgeries
Exclusion criteria
* Patients' refusal to participate in the study * history of allergy to the medications used in the study * hepatic disease * renal disease * known neurologic disorders * psychiatric disorder * chronic treatment with calcium channel blockers * hyper-magnesemia * coagulopathy * anatomical abnormalities * hemodynamic instability * local infection * suspected intra- abdominal sepsis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Duration of post-operative analgesia | 24hours | Time from completion of the block to the first request of rescue analgesia. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean arterial blood pressure | 24 hours | Measured before induction of anesthesia (base line), upon arrival to the PACU, after 30 and 60 min. If hypotension (MBP \< 20% of the base line value) occurred, 3 mg increments of ephedrine repeated every 5 min if required was given. MBP was then recorded at 2, 6, 12 and 24 post-operative hours. |
| Heart rate | 24 hours | Recorded before induction of anesthesia (base line),upon arrival to the PACU, after 30 and 60 min. If bradycardia (HR \<50 bpm) occurred, 0.5 mg atropine was given. HR was then recorded at 2, 6, 12 and 24 post-operative hours. |
| The severity of post-operative pain at rest | 24 hours | By using the Visual Analogue Scale (VAS); from 0= no pain, to 10=worst imaginable pain. Assessed upon arrival to the PACU, after 30 and 60 min. The VAS was then recorded at 2, 4, 6, 8, 12 and 24 post-operative hours. |
| The severity of post-operative pain with movement (bilateral knee flexion) | 24 hours | By using the Visual Analogue Scale (VAS); from 0= no pain, to 10=worst imaginable pain. Assessed at 2, 4, 6, 8, 12 and 24 post-operative hours |
| Number of patients requiring post-operative rescue analgesia | 24 hours | Number of patients requiring pethidine in the 24 hours post-operative period |
| Local Anesthetic Systemic Toxicity (LAST): | 24 hours | As any regional anesthesia technique with local anesthetic is associated with potential systemic absorption of local anesthetics. |
| Occurrence of nausea and/or vomiting: | 24 hours | Number of patients who develop nausea and/or vomitting |
| Time to first ambulation | 24 hours | The time to the start of movement by each patient in the 24 hours post-operative period |
| The analgesic satisfaction at 24 post-operative hours | 24 hours | Patients were asked to report their satisfaction with the pain management; assessed as, 1 = poor, 2 = fair, 3 = good, and 4 = excellent. |
| Inadvertent femoral nerve block | 24 hours | number of patients who develop lower limb weakness |
| Total dose of pethidine given | 24 hours | The cumulative total pethidine doses given to each patient in the 24 hours post-operative period. |
Countries
Egypt
Outcome results
None listed