Postoperative Pain
Conditions
Keywords
rhomboid intercostal block -serratus anterior plane block - thoracodorsal artery perforator flap
Brief summary
evaluate and compare the impact of ultrasound guided rhomboid intercostal block versus serratus anterior plane block for analgesia after thoracodorsal artery perforator flap following partial mastectomy
Detailed description
* To assess and compare quality of post- operative analgesia in each group. * Time of performance of block in both groups. * To assess and compare post-operative hemodynamics as well as anticipated adverse effects including nausea, vomiting, itching, hemorrhage, bradycardia, hypotension.
Interventions
PROCEDUREgeneral anesthesia
general anesthesia
PROCEDUREgeneral anesthesia plus Rhomboid intercostal block
the patients will be positioned in lateral decubitus with moving the scapula laterally by abducting the ipsilateral arm across the chest. under complete aseptic situations A high-frequency (6-12 MHz) linear US probe will be put medial to the medial border of the scapula in an oblique sagittal plane with the orientation marker directed cranially.at the T6-7 level, the tissue plain between the rhomboid major and intercostal muscles is identified, and a single injection of 25mL of bupivacaine (0.25%) will be administered via 18-gauge Tuohy advanced in plane from a superomedial to an inferolateral direction, followed by general anesthesia
PROCEDURESerratus anterior plane block
The patient will be positioned supine with his arm abducts at 90°. the US high frequency (6-12 MHz) linear probe of sonosite M turbo ultrasonography (FUJIFIM sonosite, Inc., Bothell, WA, USA) will be put in sagittal plane at the midaxillary line. identification of the fascial plane between the serratus anterior muscle and external intercostal muscles will be performed between the fourth and fifth ribs in the midaxillary area . At this point the18-gauge Tuohy needle will be advanced in plane with injection of 25mL of 0.25 %, bupivacaine. followed by general anesthesia
Sponsors
Zagazig University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 60 Years
Healthy volunteers
Yes
Inclusion criteria
* Adult patients aged between 21 to 60 years * Undergoing pedicled thoracodorsal artery perforator flap following breast conserving surgery -General anesthesia * Informed consents * ASA I & II * Body mass index 25-30 kg/m2.
Exclusion criteria
* patients on anti-platelet, anticoagulant or B blocker drugs * Patients with acute decompensated heart failure, hypertension, heart block, coronary disease, Asthma, bleeding disorders, compromised renal or hepatic function * history of allergy to local anesthesia or opioid analgesia, * pregnancy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| tramadol consumption | at 24 hours postoperative | The amount of tramadol consumption |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time of performance of block | time from positioning of ultrasound porbe till the end of block procedure. | Time needed to performance the block |
| Time to first dose of rescue analgesia | during the first 24 hours postoperatively | the first time that the patients need analgesia when VAS ≥ 3 |
| Anticipated side effect | at 24 hous post operative | nausea, vomiting, local anesthesia toxicity, needle injury |
| Post operative patient's satisfaction | at 24 hours post operative | Post operative patient's satisfaction using 3 point scale (1= satisfied ,2=neutral, 3=not satisfied) |
Countries
Egypt
Contacts
Primary ContactHeba M Fathi, M.D
Outcome results
None listed