Analgesic Efficacy, Dexmedetomidine, Erector Spinae Plane Block, Laparoscopic Cholecystectomy, Subcostal Transverse Abdominis Plane Block
Conditions
Brief summary
Our scientific work aimed to evaluate the analgesic efficacy of dexmedetomidine as an adjuvant to erector spinae plane block versus subcostal transverse abdominis plane block in patients undergoing laparoscopic cholecystectomy.
Detailed description
Laparoscopic cholecystectomy (LC) is the most commonly performed surgical procedure for the management of cholelithiasis. Acute pain after LC consists of somatic, parietal, and referred pain caused by trocar insertion, gall bladder resection, carbon dioxide insufflation, and other factors. The subcostal transverse abdominis plane (SCTAP) block is the deposition of local anesthetic in the transverse abdominis plane inferior and parallel to the costal margin. Ultrasound-guided erector spinae plane block (ESPB) is a popular, interfascial regional technique initially described for managing thoracic neuropathic pain. Dexmedetomidine is an alpha-2 adrenergic receptor agonist that has been the focus of interest due to its sedative, analgesic, perioperative sympatholytic, and cardiovascular-stabilizing effects, resulting in reduced anesthetic requirements.
Interventions
OTHERSubcostal transverse abdominis plane block
Patients received an ultrasound-guided subcostal transverse abdominis plane block with injection of 10 ml bupivacaine 0.25 %, 5ml lignocaine 2 % plus 0.5 μg/kg dexmedetomidine in a 20 ml volume.
OTHERErector spinae plane block
Patients will receive an ultrasound-guided erector spinae plane block (ESPB) with injection of 10 ml bupivacaine 0.25%, 5 ml lignocaine 2 % plus 0.5 μg/kg dexmedetomidine in a 20 ml volume.
Sponsors
Kafrelsheikh University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Age from 20 to 60 years. * Both sexes. * American Society of Anesthesiologists (ASA) physical status I and II. * Patients were planned to undergo laparoscopic cholecystectomy.
Exclusion criteria
* Patient's refusal to participate in the study. * ASA III, IV. * History of clinically significant cardiac, hepatic, renal, respiratory or neurological disease. * Coagulopathy and bleeding disorders. * Known allergy to any drug included in the study. * Systemic or local infection at the puncture site. * Body mass index (BMI) \>35 (kg/m2). * Failed technique.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total dose of morphine consumption | 24 hours postoperatively | If the Visual analogue scale (VAS) is ≥ 3, IV morphine was given as a bolus of 2 mg (body weight \< or = 60 kg) or 3 mg (body weight \> 60 kg) with 5 minutes' lockout interval. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean arterial pressure | 24 hours postoperatively | Mean arterial pressure was recorded at baseline, after injection then every 30 minutes till the end of surgery and after surgery at 0, 2, 4, 6, 8, 12, 16 and 24 h. |
| Intraoperative opioid consumption | Intraoperatively | Intraoperative opioid consumption was recorded. |
| Time to first rescue analgesia | 24 hours postoperatively | Time to first rescue analgesia was recorded from the end of surgery till first dose of morphine administrated. |
| Heart rate | 24 hours postoperatively | Heart rate was recorded at baseline, after injection then every 30 minutes till the end of surgery and after surgery at 0, 2, 4, 6, 8, 12, 16 and 24 h. |
| Incidence of complications | 24 hours postoperatively | Incidence of complications such as pneumothorax, local anesthetic systemic toxicity (LAST), bradycardia, hypotension, nausea, vomiting, and failed block were recorded. |
| Patient satisfaction | 24 hours postoperatively | Degree of patient satisfaction will be assessed on a 3-point scale; (1= Unsatisfied, 2= neither satisfied nor unsatisfied, 3= satisfied). |
| Degree of pain | 24 hours postoperatively | Visual analogue scale (VAS) was assessed after surgery at 0, 2, 4, 6, 8, 12, 16, 18, and 24 h \[where (0 = no pain and 10 = severe pain)\]. |
Countries
Egypt
Outcome results
None listed