Bilateral Erector Spinae Plane Block, Bilateral Oblique Subcostal Transversus Abdominis Plane Block, Postoperative Analgesia, Colorectal Surgery
Conditions
Brief summary
This study aims to compare the ultrasound-guided bilateral erector spinae plane block (ESPB) and oblique subcostal transverse abdominal plane block (OSTAPB) for postoperative analgesia in colorectal surgery.
Detailed description
Colorectal surgery remains the therapeutic cornerstone for the management of a wide variety of gastrointestinal disorders encompassing malignancies and inflammatory conditions. Oblique subcostal transverse abdominal plane block (OSTAPB) is a regional block technique that involves injecting local anesthetics between the transverse abdominal muscle plane and the internal oblique abdominal muscle plane. Ultrasound-guided erector spinae plane block (ESPB) is a novel technique that specifically targets the ventral rami, dorsal rami, and rami communicantes of the spinal nerves. Local anesthetic agents were observed to extend cranially and caudally over numerous dermatomal levels following injection.
Interventions
OTHERErector Spinae Plane Block
Patients will receive ultrasound-guided erector spinae plane block.
Patients will receive ultrasound-guided oblique subcostal transversus abdominis plane block.
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Age 18 to 75 years old. * Both sexes. * American Society of Anesthesiologists (ASA) physical status II-III. * Scheduled for open colorectal surgery under general anesthesia.
Exclusion criteria
* History of opioid abuse. * Chronic opioid consumption. * Body mass index (BMI) ≥ 35 kg/m2. * Severe cardiac insufficiency, defined as New York Heart Association (NYHA) class III or IV heart failure. * Renal failure, defined as an estimated glomerular filtration rate (eGFR) \< 30 mL/min/1.73 m². * Hepatic encephalopathy. * Having a skin infection at or near the puncture site. * Coagulopathy, defined as platelet count \< 100,000/mm³, INR \> 1.5, or use of anticoagulant therapy that could not be withheld. * Allergy to drugs used in the study. * History of previous or recurrent laparoscopic cholecystectomy procedures.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 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 0, 2, 4, 6, 12, and 24 h postoperatively. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to the first rescue analgesia | 24 hours postoperatively | Time to the first request for the rescue analgesia will be recorded from end of surgery to first dose of morphine administrated. |
| Intraoperative fentanyl consumption | Intraoperatively | Additional fentanyl bolus dosages of 1 µg/kg IV will be administered if heart rate or mean arterial blood pressure elevated more than 20% of the baseline (after exclusion of other causes than pain). |
| Total morphine consumption | 24 hours postoperatively | Rescue analgesia of morphine will be given as 3 mg bolus (maximum dose of 0.5 mg/kg/24hours) if the numeric rating scale (NRS) \> 3 to be repeated after 30 min if pain persists until the NRS \< 4. |
| Mean arterial pressure | Till end of surgery (Up to 2 hours) | Mean arterial pressure will be recorded at: * T0: Baseline reading preoperatively (in the preoperative holding area). * T1: Immediately before intubation. * T2: 15 minutes after intubation. * T3: 30 minutes after intubation. * T4: 45 minutes after intubation. * T5: 60 minutes after intubation. * T6: At the end of surgery. |
| Heart rate | Till end of surgery (Up to 2 hours) | Heart rate will be recorded at: * T0: Baseline reading preoperatively (in the preoperative holding area). * T1: Immediately before intubation. * T2: 15 minutes after intubation. * T3: 30 minutes after intubation. * T4: 45 minutes after intubation. * T5: 60 minutes after intubation. * T6: At the end of surgery. |
| 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). |
| Quality of Recovery | 24 hours postoperatively | Quality of Recovery (QOR- 15) scale will be recorded at 24 hours after surgery. Each item on the QoR-15 scale is scored from 0 (unfavourable) to 10 (favourable), resulting in an aggregate score from 0 (no recovery) to 150 (total recovery). |
| Incidence of adverse events | 24 hours postoperatively | Incidence of adverse events such as bradycardia, hypotension, nausea, vomiting, respiratory depression, or any other complication will be recorded. |
Countries
Egypt
Contacts
CONTACTMohammed M Alarousy, MSc
Outcome results
None listed