Ultrasound, Surgical, Rectus Sheath Block, Local Anesthesia Infiltration, Postoperative Analgesia, Total Abdominal Hysterectomy
Conditions
Brief summary
The aim of this work is to compare the efficacy and safety of the effectiveness and safety of ultrasound-guided surgical rectus sheath block and local anesthetic infiltration for postoperative analgesia in patients undergoing total abdominal hysterectomy.
Detailed description
Total abdominal hysterectomy (TAH) is a commonly performed major surgical procedure that results in substantial postoperative pain and discomfort. Local anesthetic infiltration (LAI) at the end of surgery is one of the most common technique employed in laparotomies for postoperative analgesia. Rectus sheath block (RSB) has been used as a part of multimodal analgesia, especially when neuraxial techniques are unsuitable.The RSB was used to achieve peri-operative relaxation of the anterior abdominal wall.
Interventions
Patients will receive ultrasound-guided rectus sheath block (20 ml bupivacaine 0.25%) bilaterally at the end of surgery.
Patients will receive a surgical rectus sheath block (20 ml bupivacaine 0.25%) bilaterally at the time of closure.
Patients will receive local anesthesia infiltration at the end of surgery.
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 from 18 to 65 years old. * American Society of Anesthesiologists (ASA) physical status I - II. * Patients scheduled for elective total abdominal hysterectomy under general anesthesia.
Exclusion criteria
* Hepatic, renal or cardiac disease. * Any known allergy to local anesthetic. * Physical or mental conditions which may vaguely measure 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 | Rescue analgesia of morphine will be given as 3 mg bolus if the Visual Analogue Scale (VAS)\> 3 to be repeated after 30 min if pain persists until the VAS \< 4. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean arterial pressure | Till the end of surgery (Up to 4 hours) | Mean arterial pressure will be recorded preoperative, before performing of block, and every 15 min till the end of surgery. |
| Time to the first request for the rescue analgesia | 24 hours postoperatively | Time to the first request for the rescue analgesia (time from end of surgery to first dose of morphine administrated). |
| Heart rate | Till the end of surgery (Up to 4 hours) | Heart rate will be recorded preoperatively, before the block is performed, and every 15 minutes until the end of the surgery. |
| Degree of patient satisfaction | 24 hours postoperatively | 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). |
| Incidence of adverse events | 24 hours postoperatively | Incidence of adverse events such as hematoma, nerve damage or neuropathy, bradycardia, hypotension, nausea, vomiting, pruritis, urinary retention, or any other complication will be recorded. |
| 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 at PACU, 2, 4, 6, 12, 18, and 24h postoperatively. |
Countries
Egypt
Contacts
Primary ContactSarah A Afifi, MD
Outcome results
None listed