Analgesia, Epigastric Hernia, Recto-intercostal Fascial Plane Block
Conditions
Brief summary
The aim of this study is to evaluate the efficacy and safety bilateral recto-intercostal fascial plane block (RIFPB) in epigastric hernia.
Detailed description
Epigastric hernias are usually occult in obese patients, and their symptoms may mimic peptic ulcer or gallbladder disease . Hernia repair is associated with considerable postoperative pain. The recto-intercostal fascial plane block (RIFPB) is a new novel approach that was developed by Tulgar et al., 2023 who hypothesized that when we inject a local anesthetic into the interfacial plane just inferolateral to the xiphoid, between the rectus abdominis muscle and the 6-7th costal cartilages (hence, between the cartilages and the intercostal muscles between them), blockade of the anterior branches of the nerves passing through this area can be guaranteed.
Interventions
Patients will receive bilateral recto-intercostal fascial plane block using 20 mL of bupivacaine 0.25% on each side.
DRUGbupivacaine
bupivacaine 0.25%
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age 18-65 years. * Both sexes. * American Society of Anesthesiology (ASA) physical status I-II. * Scheduled for elective epigastric hernia repair.
Exclusion criteria
* Obese patients with body mass index (BMI) \>35 kg/m2. * Patients with a large hernia containing bowel. * Patients with local anesthetic allergy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to the 1st rescue analgesia | 24 hours postoperatively | Rescue analgesia in the form of 3 mg of IV morphine will be given if the numeric rating scale (NRS) score \> 3. NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total morphine consumption in the 1st 24hr | 24 hours postoperatively | Rescue analgesia in the form of 3 mg of IV morphine will be given if the numeric rating scale (NRS) score\> 3. |
| Pain score | 24 hours postoperatively | Each patient will be instructed about postoperative pain assessment with the Numeric Rating Scale (NRS) score. NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). Postoperative pain using NRS at rest and during coughing or movement will be measured at PACU, 2h. 4hr, 6h, 8h, 12h, 18h and 24h postoperative |
| Intraoperative fentanyl consumption | Intraoperatively. | Additional bolus doses of fentanyl 1 µg/kg IV will be given if there is increase in heart rate or mean arterial blood pressure more than 20% of the base line (after exclusion of other causes than pain). |
| Intraoperative mean arterial pressure | Till the end of surgery. | Mean arterial pressure (MAP) will be recorded preoperative, before performing of block, and every 15 min till the end of surgery. |
| Intraoperative heart rate | Till the end of surgery. | Heart rate (HR) will be recorded preoperative, before performing of block, and every 15 min till the end of surgery. |
| Complications | 24 hours postoperatively | Such as pneumothorax, nausea, vomiting, hematoma, hypotension, bradycardia and local anesthetic toxicity will be recorded. |
Countries
Egypt
Outcome results
None listed