Analgesia, Erector Spinae Plane Block, Midpoint Transverse Process Plane to Pleura Block, Thoracoscopic Sympathectomy, Transverse Thoracic Plane Block
Conditions
Brief summary
This study compares the transversus thoracic muscle plane block (TTPB), midtransverse to pleura block (MTPB), and erector spinae plane block (ESPB) for postoperative analgesia in patients undergoing thoracoscopic sympathectomy.
Detailed description
Thoracoscopic sympathectomy is a well-established procedure for the treatment of various hyperhidrosis disorders and certain vascular conditions, involving the division of sympathetic nerve fibers in the thoracic cavity. The erector spinae plane block (ESPB) is an interfascial regional anesthesia block for thoracic analgesia which can be performed by superficial or deep needle approach. The mid-transverse to pleura block (MTPB) was first described as a modified paravertebral block. Transversus thoracic muscle plane block (TTPB) is a newly developed technique in which LA is injected into the fascial plane between the transversus thoracic muscle and the internal intercostal muscles for blocking the anterior cutaneous branches of intercostal nerves from thoracic (Th) 2 to Th 6.
Interventions
Patients will receive a transverse thoracic plane block.
OTHERMidpoint transverse process plane to pleura block
Patients will receive a midpoint transverse process plane to pleura block.
OTHERErector spinae plane block
Patients will receive an erector spinae plane block.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age from 18 to 65 years. * Both sexes. * American Society of Anesthesiology (ASA) physical status I-II. * Scheduled for thoracoscopic sympathectomy
Exclusion criteria
* Coagulopathy. * History of opiate abuse. * Pre-existing chronic pain. * Allergy to local anesthetics or analgesics. * Infection at the site of injection. * Mental or neurological disorders. * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to the 1st 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) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 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 0, 4, 8, 12, 18 and 24h postoperatively. |
| Heart rate | Till the end of surgery (Up to 2 hours) | Heart rate will be recorded preoperatively, before performing of block, and every 15 min till the end of surgery. |
| 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 |
| 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 complications | 24 hours postoperatively | Incidence of complications such as pneumothorax, bradycardia, hypotension, nausea, vomiting, pruritis, respiratory depression, or any other complication will be recorded. |
| Mean arterial pressure | Till the end of surgery (Up to 2 hours) | Mean arterial pressure will be recorded preoperatively, before the block is performed, and every 15 minutes until the end of the surgery. |
Countries
Egypt
Outcome results
None listed