Post Operative Analgesia
Conditions
Keywords
post operative analgesia,, erector spinae plane block, Quadratus Lumborum Blocks, Abdominal Hysterectomy
Brief summary
TAH, being a large scale gynaecological operation, is a construction bound to cause serious postoperative pain to the patient in that the procedure will inevitably entail massive tissue dissection. Management of this postoperative pain is of utmost significance because poor analgesia may lead to delayed mobilization of the patient, long duration of hospitalization and also general increase in the morbidity of postoperative period. Traditionally, in these facilities, opioid analgesics are the most common and the most popular means of controlling postoperative pain. Nevertheless, the varied and pervasive use of opioids is largely constrained by its well-reported, dose-dependent systemic adverse effects. Nausea, vomiting, sedation, and respiratory depression are complications that severely degrade the recovery process of the patient and reduce his or her satisfaction.
Detailed description
Patients who met the inclusion criteria were recruited in the trial after getting approval from the Hospital Ethical Review Committee and REU CPSP. Demographic information such as age, height, weight, body mass index as well as the functional classification (ASA) was documented on a pre-made proforma. Patients were randomized into two groups using a computer-generated randomisation process. Group A: Received an ultrasound-guided erector spinae plane block at the T9-T10 level using 20 ml of 0.25% bupivacaine. Group B: Received an ultrasound-guided posterior quadratus lumborum block using 20 ml of 0.25% bupivacaine. A qualified anaesthesiologist performed each block in aseptic settings prior to surgery. Standardised general anaesthesia was administered to each patient. The Visual Analogue Scale (VAS) was used to quantify pain at rest and on coughing at 2, 6, 12, 18, and 24 hours. Patents with VAS score more than 4, were given rescue analgesia and the cumulative amount of analgesics used in the first 24 hours as well as the time of the first rescue analgesia were recorded. Patient satisfaction with pain treatment as well as adverse effects such nausea, vomiting, and hypotension were tracked for a duration of 24 hours after the surgery
Interventions
PROCEDUREErector Spinae Plane Block
Ultrasound-guided erector spinae plane block at the T9-T10 level using 20 ml of 0.25% bupivacaine.
PROCEDUREQuadratus Lumborum Block (QLB)
Ultrasound-guided posterior quadratus lumborum block using 20 ml of 0.25% bupivacaine.
Sponsors
Sheikh Khalifa Bin Zayed Al Nahyan Combined Military Hospital Muzaffarabad
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
FEMALE
Age
35 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
Patients aged 35-60 years. ASA physical status I or II. Elective Total Abdominal Hysterectomy under General Anesthesia.
Exclusion criteria
Allergy with local anesthetics. Infection in the injection site. Coagulopathy or anticoagulant use. Morbid obesity (BMI \> 35 kg/m²).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Post Operative Pain | 24 Hours | Visual Analogue Score a one-dimensional indicator of pain severity. It is made up of a horizontal line that is 10 cm (100 mm) long and has two end points marked "No Pain" (0) and "Worst Possible Pain" (10). On the line, the patient marks the point that most accurately depicts their level of discomfort at 2,4,6,18 \& 24 hours post operatively. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to first Rescue Analgesia | 24 Hourse | When a patient's pain score surpasses a certain threshold (e.g., VAS \> 4), additional analgesic medication is administered when the primary anaesthetic approach is unable to give sufficient pain relief and the time will be calculated in hours. |
| Cumulative Opioid consumption | 24 Hours | The total amount of opioid medicine needed by the patient over the course of the first 24 hours following surgery in order to sustain sufficient analgesia. This is frequently computed as the Morphine Equivalent Dose (mg) and standardised. |
| Adverse effects | 24 Hours | Unwanted and unpleasant effects like nausea, vomiting during 24 hours post operatively |
| Patient Satisfaction | 24 Hours | A conventional 5-point Likert scale that ranges from "Very Dissatisfied" to "Very Satisfied" is usually used to gauge the patient's subjective assessment of the level of pain care they got during 24 hours duration post-operatively |
Countries
Pakistan
Contacts
CONTACTHamid Altaf Altaf
Outcome results
None listed