Provide Post Hepatectomy Pain Control
Conditions
Keywords
External Oblique Intercostal block, subcostal incision, hepatectomy, Patient control analgesia
Brief summary
The majority of cases undergoing hepatectomy suffer from inadequate postoperative analgesia. Therefore, multimodal analgesic techniques are required to relieve pain and discomfort such as intravenous, and epidural analgesia, and peripheral nerve blocks. Although epidural catheters are efficient to provide perioperative analgesia, in this type of surgery patients may be more susceptible to catheter related complications due to the alteration in coagulation parameters. That is why safer alternatives are sought for those patients. The use of patient-controlled analgesia (PCA) for postoperative pain management improves patients' quality of recovery. However, there are many concerns regarding the type of opioids used in PCA such as overdosing, underdosing, and the effect of the hepatectomy on the drug metabolism in those patients. External oblique intercostal plane block (EOI block) is a relatively novel block used in upper abdominal incisions especially subcostal laparotomy to provide intraoperative and postoperative analgesia. This study aims to compare the efficacy of Bilateral External Oblique Intercostal Plain Block versus PCA in pain management and reduction of opioid use in hepatectomy surgery done by subcostal incision.
Interventions
PROCEDUREExternal Oblique Intercostal Plane Block
The block is performed before skin incision by a specialized anesthetist. With the patient positioned in the supine position with their ipsilateral arm abducted, the skin was sterilized, using the high frequency linear probe (M-Turbo HF 38 transducer 13- 6 MHz) of Fujifilm Sonosite ultrasound is placed over the sixth rib medial to the anterior axillary line approximately in midclavicular line in a parasagittal orientation. A 20-guage needle is inserted in a cephalocaudal direction, and the external oblique intercostal plane was hydro dissected with saline. After hydro dissection, the needle is advanced 1 to 2 cm, and 20 mL of 0.25% bupivacaine (Sunny Pharmaceutical) with 4 mg dexamethasone as an additive was administered. The same procedure will be done at the other side (bilateral external oblique intercostal plane block).
DEVICEPatient controlled analgesia
Patients in group will receive intravenous patient controlled analgesia device 100 ml (Accuafuser 100 mL, basal rate 4 mL/hr., bolus 0.5 mL/time, and lock time 15 minutes) for postoperative pain management that will contain 30 mg morphine (loading dose0.1mg/kg) will be given by infusion over 10 minutes then accuafuser will be connected),8 mg dexamethasone and 8 mg ondansetron diluted in 100 ml saline.
Sponsors
Sherif Alaa Embaby
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 and ≤ 65 Years. * Both sexes. * Patients will be scheduled for hepatectomy surgery. * Body mass index (BMI) 18.5-30.0 /m 2 .
Exclusion criteria
* Extension of the surgical incision beyond coverage of T12 dermatome. * Prolonged time of surgery > 5 hours. * Hepatectomy surgery combined with another organ resection. * Patients with hypersensitivity to local anesthetics. * History of psychiatric problems. * Recent history of analgesic drugs including opioid abuse or addiction. * Coagulopathy (International normalized ratio \[INR\] > 1.4). * Localized infection at the block site. * Morbidly obese patients.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| • Rescue morphine consumption in both groups. (Total consumption of morphine rescue shots in milligram in first 2r hours) | twenty four hours. |
Contacts
Primary ContactSherif A Embaby, Consultant
Outcome results
None listed