Intrathecal Morphine, Postoperative Analgesia, Rectus Sheath Block, Total Abdominal Hysterectomy, Ultrasound
Conditions
Brief summary
This study aims to compare the effectiveness and safety of ultrasound-guided rectus sheath block versus intrathecal morphine for postoperative analgesia in patients undergoing open total abdominal hysterectomy.
Detailed description
Effective postoperative analgesia is crucial for enhancing recovery and patient satisfaction following major surgical procedures, such as total abdominal hysterectomy (TAH). Rectus sheath block (RSB), an ultrasound-guided regional anesthesia technique, involves the injection of local anesthetic into the rectus sheath, providing analgesia to the anterior abdominal wall. RSB is used to block the sensory nerves of the anterior abdominal wall and thereby contributing to pain relief after lower abdominal surgeries. Intrathecal morphine (ITM) provides a highly effective method of analgesia by delivering the medication directly into the cerebrospinal fluid (CSF).
Interventions
DRUGRectus sheath block
Patients will receive rectus sheath block (20 ml bilaterally, bupivacaine 0.25%) after induction of general anesthesia.
DRUGIntrathecal morphine
Patients will receive 150 µg intrathecal morphine after induction of general anesthesia.
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age: 18 - 65 years old. * American Society of Anesthesiologists (ASA) physical status (I -II). * Patients undergoing open total abdominal hysterectomy.
Exclusion criteria
* Hepatic, renal, or cardiac disease. * Any known allergy to local anesthetic. * Physical or mental conditions which may vague measuring postoperative pain following surgery. * History of chronic use of analgesic as nonsteroidal anti-inflammatory drugs (NSAIDs) or central nervous system (CNS) depressants as antiepileptic, and bleeding disorders.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total morphine consumption | 24 hours postoperatively | Morphine will be administered if the visual analog scale (VAS) score is ≥ 4. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to the first request for the rescue analgesia | 24 hours postoperatively | Time to the first request for the rescue analgesia (time from the end of surgery till first dose of morphine administrated) |
| Degree of pain | 24 hours postoperatively | Each patient will be instructed about postoperative pain assessment with the Visual Analogue Scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS will be assessed after surgery over 24 hour using VAS scale at (post-anesthesia care unit, 2, 4, 6, 12, 18, and 24 h). |
| Degree of sedation | Intraoperatively | Sedation will be assessed using Modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S): (5 Alert: Responds readily to name spoken in normal tone, 4: Lethargic response to name spoken in normal tone, 3: Responds only after name is called loudly and/or repeatedly, 2: Responds only after mild prodding or shaking ,1: Responds only after painful trapezius squeeze,0: Does not respond to painful trapezius squeeze). |
| Degree of patient satisfaction | 24 hours postoperatively | The degree of patient satisfaction will be assessed on a 5-point Likert scale patient satisfaction (1, extremely dissatisfied; 2, unsatisfied; 3, neutral; 4, satisfied; 5, extremely satisfied). |
| Time of hospital discharge | 28 days postoperatively | Time of hospital discharge will be recorded from admission till the discharge from hospital. |
| Incidence of adverse events | 24 hours postoperatively | Incidence of adverse events such as hematoma, nerve damage or neuropathy, bradycardia, hypotension, nausea, vomiting, pruritis, or any other complication will be recorded. |
Countries
Egypt
Outcome results
None listed