Post Operative Analgesia
Conditions
Keywords
Rectus shealth block, External oblique intercostal plane block
Brief summary
The current study is designed to investigate the analgesic potentials of two modalities of abdominal blocks where local anesthetics is injected in the fascial planes of the abdominal muscles to anesthetize the nerves supplying the abdomen in patients undergoing upper abdomial surgeries. the two modalities are the rectus sheath block (RSB) and the external oblique intercostal plane block (EOIPB). The investigators are going to use the ultrasound to identify the muscles and inject the local anesthetics. The investigators suggest that the EOIPB might provide better pain control when compared to RSB.
Detailed description
Fascial plane blocks emerge as an appealing technique to provide good intraoperative and postoperative analgesia in patients undergoing upper abdominal surgeries. Such techniques have the benefit of decreasing opioids use and consequently reducing the like hood of their side effects. Ultrasound guided rectus sheath Block (RSB) targets the terminal branches of thoracic nerves thus providing analgesia for midline abdominal incisions. Ultrasound guided external oblique intercostal plane block (EOIPB), a relatively new technique, targets the lateral cutaneous branches of the thoracoabdominal nerves providing analgesia for anterolateral and upper median plane of the abdomen. Studies Comparing both techniques are deficient, that is why the investigators designed the current study to evaluate and compare the analgesic efficacy of both techniques in upper abdominal surgeries namely Whipple operation and total gastrectomy. The study is a randomized controlled double blinded trial comprising two groups. The RSB group will receive bilateral ultrasound guided rectus sheath block with 20ml of 0.25% bupivacaine on each side. The EOIB group will receive bilateral ultrasound guided External oblique intercostal plane block with 20ml of 0.25% bupivacaine on each side as well. Both blocks will be performed after administering general anesthesia. The main endpoint of the study is the time to first request for rescue analgesia.
Interventions
After receiving general anesthesia, bilateral ultrasound guided rectus sheath block with 20 ml of 0.25% bupivacaine on each side will be administered to 20 patients undergoing upper abdominal surgeries namely whipple operation and total gastrectomy
After receiving general anesthesia, bilateral ultrasound guided external oblique intercostal plane block with 20 ml of 0.25% bupivacaine on each side will be administered to 20 patients undergoing upper abdominal surgeries namely whipple operation and total gastrectomy
Sponsors
Kasr El Aini Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Investigator)
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 Anesthesiologists (ASA) physical status II, III. * Patients who will undergo upper abdominal surgeries (Whipple operation, total gastrectomy).
Exclusion criteria
* Coagulation disorders. * Abdominal surgery history. * Infection in the block application area. * Chronic opioid use. * Local anesthetic (LA) allergy. * Pregnancy. * BMI ≥35 kg/m2. * Severe cardiovascular problems. * Diabetic neuropathy. * Complicated surgeries with massive blood loss and hemodynamic instability.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to first request for rescue analgesia | Time in hours from end of surgery to first dose of morphine administered up to 24 hours postoperatively | Time from end of surgery to first dose of morphine administered |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Fentanyl consumption | From the start of the surgery till the end in micogram/Kg | Intraoperative fentanyl consumption |
| Postoperative morphine consumption | from the time numerical rating scale exceeds 3 and till 24 hours after the end of the surgery | Total morphine consumption (mg) in the first 24hrs after surgery |
| Pain score | from the time of recovery immediately in the postoperative period and then at 30 minutes, 1 hour, 2 hours, 4 hours, 6 hours, 12 hours and 24 hours postoperatively | Pain score using Numerical rating Scale (NRS)between 0 and 10, Zero means no pain and ten means the worst pain |
| Patient satisfaction of analgesia | 2 hours after recovery from anesthesia | 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 postoperative nausea and vomiting | From the recovery of anesthesia and up to 24 hours postoperatively | The number of patients suffering from postoperative nausea and vomiting in both groups |
Countries
Egypt
Outcome results
None listed