Edge of Laminar Block, Erector Spinae Plane Block, Postoperative Analgesia, Video-Assisted Thoracoscopic Surgery
Conditions
Brief summary
This study aims to compare the ultrasound-guided edge of laminar block (ELB) and erector spinae plane block (ESPB) for postoperative analgesia in patients undergoing video-assisted thoracic surgery (VATS).
Detailed description
Postoperative pain after thoracic surgery, which is attributed to muscle incisions, rib retractions, and intercostal nerve damage, may be severe enough to cause pulmonary complications, such as atelectasis, pneumonia, and increased oxygen consumption. The erector spinae plane block (ESPB) is used for managing post-thoracotomy pain and has numerous advantages that make it an attractive alternative technique. The ESPB injects a local anaesthetic around the erector spinae muscle at approximately the level of the T5. It may be able to block the dorsal and ventral rami of the thoracic spinal nerves. A novel technique of retrolaminar block (RLB) called the edge of laminar block (ELB) to provide sensory analgesia during rib fracture surgery.
Interventions
OTHEREdge of laminar block
Patients will receive edge of laminar block using 20ml of bupivacaine 0.25%.
OTHERErector spinae plane block
Patients will receive an erector spinae plane block using 20ml of bupivacaine 0.25%.
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. * Undergoing video-assisted thoracic surgery (VATS) under general anesthesia.
Exclusion criteria
* History of allergies to local anesthetics. * Opioid dependency. * Bleeding or coagulation disorders. * Psychiatric and neurological disorder. * Local infection at the site of injection. * Severe heart, lung, liver, and renal dysfunction. * Pregnant or lactating women.
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 numeric rating scale (NRS)\> 3 to be repeated after 30 min if pain persists until the NRS \< 4. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to the 1st rescue analgesia | 24 hours postoperatively | Time to the first request for the rescue analgesia (time from the end of surgery to first dose of morphine administrated). |
| Intraoperative fentanyl consumption | Intraoperatively | Additional fentanyl bolus dosages of 0.5 µg/kg IV will be administered if heart rate or mean arterial blood pressure elevated more than 20% of the baseline. |
| 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. |
| Mean arterial pressure | Till the end of surgery (Up to 2 hours) | Mean arterial pressure will be recorded preoperatively, before performing of block, and every 15 min till the end of surgery. |
| Degree of pain | 24 hours postoperatively | Each patient will be instructed about postoperative pain assessment with the numeric rating scale (NRS). NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). NRS will be assessed at post-anesthesia care unit (PACU), 2, 4, 6, 8, 12, 18, and 24 h postoperatively. |
| Incidence of adverse events | 24 hours postoperatively | Incidence of adverse events such as bradycardia, hypotension, nausea, vomiting, respiratory depression, pruritus, urinary retention, itching, constipation, or any other complication. |
Countries
Egypt
Outcome results
None listed