Postoperative Analgesia, Retrolaminar Block, Ultrasound-guided Erector Spinae Plane Block, Thoracotomy
Conditions
Brief summary
Comparing efficacy of Ultrasound-guided Erector Spinae Plane Block versus Retrolaminar Block for Postoperative Analgesia in Patients Undergoing Thoracotomy
Detailed description
Thoracotomy is one of the most painful surgical procedures. The reported incidence of persistent pain after thoracic surgery (post thoracotomy pain syndrome) has been reported in 20%-70% of patients. Inadequately treated post thoracotomy pain can have several negative consequences. Therefore, pain relief is essential to facilitate coughing and deep breathing and to promote early mobilization. Thoracic epidural analgesia and thoracic paravertebral block are strongly recommended techniques for managing post thoracotomy pain to reduce opioid use and the related adverse effects as hypoventilation, depression of cough reflex, nausea and vomiting. However, they can be technically challenging to perform and are associated with up to 15% failure rate in Thoracic epidural analgesia and potential risk of pneumothorax in thoracic paravertebral block. Erector spinae plane block is a relatively novel ultrasound-guided regional technique. Its application in patients with chronic thoracic neuropathic pain and acute surgical pain has been described by Forero et al. Retrolaminar block is an easy and safe analgesic technique. It has been reported to be satisfactory for post-operative analgesia after breast surgery. To our knowledge there is no clinical studies, comparing the effectiveness of both blocks on postthoracotomy pain, has been reported.
Interventions
ultrasound-guided ipsilateral Erector Spinae Plane Block (20 ml (19ml bupivacaine 0.25% plus 1ml dexamethasone 4mg)).
PROCEDURERetrolaminar Block
ultrasound-guided ipsilateral Retrolaminar Block (20 ml (19ml bupivacaine 0.25% plus 1ml dexamethasone 4mg)).
PROCEDUREControl
General anesthesia
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
An anesthesiologist gave the block and outcomes were obtained by another one blinded to the study group. PHILIPS ultrasound machine and high frequency linear array probe with a frequency of 5-13 MHZ will be used.
Intervention model description
Patients were randomly allocated into 3 equal groups (Control group, Ultrasound-guided Erector Spinae Plane Block group, Retrolaminar Block, 20 patients each) through sealed envelopes.
Eligibility
Sex/Gender
ALL
Age
21 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* Adult patients aged 21-65 years old of both sexes. * Patients were scheduled for elective thoracotomy. * Their ASA physical status classification is II-III.
Exclusion criteria
* Patients' refusal. * Local infection at the site of block. * Coagulation abnormalities. * Sever spinal deformity e.g. scoliosis. * Known hypersensitivity to local anesthetics. * Mental dysfunction and cognitive disorders. * History of drug abuse and chronic analgesic use.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain assessment | 24 hours postoperatively. | The Numeric Pain Rating Scale is a valid and simple approach to pain assessment (0= no pain and 10= worst possible pain). Postoperative pain will be assessed at emergence and 2nd, 4th, 8th, 12th, 18th and 24th hour postoperatively. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The time of first analgesic request | 24 hours postoperatively | The time of first analgesic request. IV morphine sulphate 0.05 mg/kg will be administered as rescue analgesic if Numeric Pain Rating Scale is ≥ 4. |
| The total amount of morphine | 24 hours postoperatively | The total amount of morphine consumption in the first 24 hours postoperatively. |
Countries
Egypt
Outcome results
None listed