Paraumbilical Hernia
Conditions
Brief summary
AIM OF STUDY: Comparison between effect of external oblique intercostal plane block and the subcostal transversus abdominis plane block in paraumbilical hernia repair as analgesia for intraoperative and postoperative pain.
Detailed description
A paraumbilical hernia is a hole in the connective tissue of the abdominal wall in the midline with close approximation to the umbilicus. If the hole is large enough there can be protrusion of the abdominal contents, including omental fat and/or bowel. These defects are usually congenital and are not noticed until they slowly enlarge over an individual's life time and abdominal contents herniate through the hole creating either pain or a visible lump on the abdominal wall. If abdominal contents get incarcerated (or stuck) in the hole this can cause pain. If the abdominal contents become strangulated by losing their blood supply from pinching or twisting those tissue will die. If it is omental fat this will cause pain and could potentially lead to an infection. If the strangulated contents are bowel then in addition to pain the individual will develop a bowel obstruction. And if the dead bowel is not surgically removed in an emergent fashion the condition could be fatal. Postoperative pain is the major obstacle for early postoperative ambulation and increases the risk of venous thromboembolism and respiratory complications and prolongs the hospital stay. This pain is routinely managed using opiates, which are associated with several side effects, including excessive sedation and postoperative nausea and vomiting (PONV) which may increase hospital stay durations. Transversus abdominis plane (TAP) block is a regional anesthetic technique that has gradually become an alternative for postoperative pain control during laparoscopic abdominal surgeries. It involves the infusion of local anesthetic into the fascial plane of the abdominal wall. the subcostal transversus abdominis plane block (TAP) targets the upper abdominal wall. The EOI block represents an important modification that cover the upper lateral abdominal wall. subcostal transversus abdominis plane (SCTAP) block is an US-guided regional anesthesia technique that anesthetizes the nerves of the lower and upper anterior abdominal wall,specifically from T6 to L1. The SCTAP has been described that can be performed to provide analgesia for abdominal surgery extending above the umbilicus.
Interventions
For the external oblique intercostal plane block, patients were positioned supine. After skin disinfection and sterile preparation, a high-frequency linear ultrasound probe was used. The probe was placed in a longitudinal parasagittal orientation at the level of the ninth rib between the midclavicular and anterior axillary lines. A 21-gauge, 10-cm needle was advanced using an in-plane technique at a shallow angle until the fascial plane deep to the external oblique muscle above the ninth rib was reached. After negative aspiration, 20 mL of 0.25% bupivacaine was injected slowly on each side
PROCEDURETransversus abdominis plane (TAP) block
For the subcostal transversus abdominis plane block, patients were positioned supine with adequate exposure of the abdominal wall. After sterile preparation, a high-frequency linear ultrasound probe was placed below the costal margin near the midclavicular line. A 21-gauge, 10-cm needle was advanced under ultrasound guidance until the transversus abdominis plane was reached (between the rectus abdominus and transversus abdominus muscle. After negative aspiration to exclude intravascular or intraperitoneal placement, 20 mL of 0.25% bupivacaine was injected slowly on each side
Sponsors
Assiut University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
1. Age between 18 and 65 years with a body mass index (BMI) of 18-35 kg/m2 2. patients with the American Society of Anesthesiologists (ASA) physical status I/II 3. Patients scheduled for elective paraumbilical hernia
Exclusion criteria
* 1-Known hypersensitivity to the study drugs. 2-Body Mass Index \> 40 kg/m2. 3- Inability to accurately describe postoperative pain to investigators. 4-Opioid tolerance or dependence. 5-Preexisting history of chronic pain. 6-History of renal, liver, cardiac, neuropsychiatric disorder problems. 7-Bleeding or coagulation abnormality. 8-Patients who received any analgesic 24 h before surgery 9-Patients who have difficulty understanding the study protocol
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The effect between external oblique intercostal plane block and the transversus abdominis plane block in paraumbilical hernia repair as analgesia for intraoperative and postoperative pain according to numeric rating score (NRS) | baseline | numeric rating scale : from 0 to 10 0 : no pain 1 - 3 : mild pain 4 - 6 : moderate pain 7 - 9 : severe pain 10 : worst pain possible |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| time of the first opioid request | baseline | time of the first opioid request all over 24 hours postoperatively. |
| Heart rate | baseline | heart rate will be recorded at time 0 then every 15 minutes in the first 2 hours, then at 6, 12, 24 hours postoperatively. |
| Mean arterial blood pressure | baseline | mean arterial blood pressure will be recorded at time 0 then every 15 minutes in the first 2 hours, then at 6, 12, 24 hours postoperatively. |
| time to start ambulation | baseline | time of the patient first movement will be recorded |
Countries
Egypt
Contacts
STUDY_CHAIRNawal A Gadelrab, Professor
Assiut University
STUDY_CHAIRAbdelrahim M Mohamed, Professor
Assiut University
PRINCIPAL_INVESTIGATORMohamed G Hassan, Resident
Assiut University
STUDY_CHAIRMohammed mamdouh mahmoud, lecterer
Assiut University
Outcome results
None listed