Post Operative Pain
Conditions
Keywords
Rhomboid intercostal block
Brief summary
Our aim is to measure the efficacy of rhomboid intercostal subserratus plane block and erector spinae plane block in patients undergoing open nephrectomy
Detailed description
Open nephrectomy incision is associated with a high incidence of intense immediate postoperative pain and chronic pain the months following surgery. Regional anesthesia techniques are commonly recommended for pain management in open nephrectomy as they decrease parenteral opioid requirements and improve patient satisfaction. Rhomboid intercostal subserratus plane block (RISS) is considered a novel approach for chest wall and upper abdominal analgesia, initially showed promising results, first reported in 2016. Erector Spinae Plane block (ESB), was initially described in 2016 for analgesia in thoracic neuropathic pain. It has also been widely used in both adults and children at different levels for different indications. Epidural analgesia is the gold standard for perioperative analgesia in open surgery.
Interventions
Fascial plane block
PROCEDUREErector spinae plane block
Fascial plane block
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
1. Type of surgery; open nephrectomy. 2. Physical status ASA II, III. 3. Body mass index (BMI): \> 20 kg/ m2 and \< 35 kg/ m2.
Exclusion criteria
1. Patient refusal. 2. Local infection at the puncture site. 3. Severe respiratory or cardiac disorders. 4. Advanced liver or kidney disease. 5. History of psychological disorders and/or chronic pain. 6. Contraindication to regional anesthesia e.g. local sepsis, pre- existing peripheral neuropathies and coagulopathy. 7. Patients with known sensitivity or contraindication to amide local anesthetics used in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The total amount of morphine consumption in (mg) | first 24 hours postoperatively. | amount of morphine in mg consumed in 1st 24 hours |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total amount fentanyl in (microgram) | intra operative duration | total amount of intraoperative fentanyl consumed in micrograms |
| Change in heart rate in (beat/min) | From just before induction till 24 hours post operatively | Readings will be taken as baseline preoperative reading, immediately after surgical incision and at 15-minute intervals intraoperatively and 30 minutes,2,4,8,12,16 and 24 hours postoperatively |
| Time of first request of analgesia | first 24 hours postoperatively | calculated from the time of complete injection of local anesthetics till the numerical pain rating scale (NRS) is ≥3.(NRS requires the patient to rate their pain on a defined scale. For example, 0-10 where 0 is no pain and 10 is the worst pain imaginable) |
| Numeric Pain Rating Scale | first 24 hours postoperatively | A numerical rating scale (NRS) requires the patient to rate their pain on a defined scale. For example, 0-10 where 0 is no pain and 10 is the worst pain imaginable |
| Nausea and vomiting Scores | first 24 hours postoperatively | Nausea and vomiting Scores using a four-point verbal scale. (None =no nausea, mild =nausea but no vomiting, moderate=vomiting one attack, severe =vomiting \>one |
| Change in mean arterial blood pressure in (mmHg) | From just before induction till 24 hours post operatively | Readings will be taken as baseline preoperative reading, immediately after surgical incision and at 15-minute intervals intraoperatively and 30 minutes,2,4,8,12,16 and 24 hours postoperatively |
Countries
Egypt
Outcome results
None listed