Abdominal Hysterectomies, Superior Hypogastric Plexus Block, Transversus Abdominis Plane Block
Conditions
Brief summary
This study aims to evaluate the analgesic effect of superior hypogastric plexus block combined with transversus abdominis plane block in abdominal hysterectomies.
Detailed description
Abdominal hysterectomy is a major surgery that is often associated with pronounced postsurgical pain. Inadequate postoperative analgesia can lead to postoperative complications and can delay functional recovery. Accordingly, a multimodal regimen for postoperative pain management is recommended. The transverse abdominis plane (TAP) block is a regional block anesthetizing the nerves (T10 to L1) hence covering the lower abdominal wall. The superior hypogastric plexus (SHP), which lies retroperitoneally in front of the L5 and S1 vertebrae, provides innervation to the pelvic viscera. The blockade of SHP is well-recognized for the management of chronic pelvic pain.
Interventions
OTHERSuperior hypogastric plexus block + Transverse abdominis plane
Patients will receive superior hypogastric plexus block (SHPB) using 20ml of bupivacaine 0.25%+ transverse abdominis plane (TAP) block using 20ml of bupivacaine 0.25%.
Patients will receive superior hypogastric plexus block (SHPB) using 20ml of saline 0.9% (sham)+ transverse abdominis plane (TAP) 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
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years. * American Society of Anesthesiology (ASA) physical status I-II. * Undergoing abdominal hysterectomies under general anesthesia (GA).
Exclusion criteria
* History of allergies to local anesthetics. * Body mass index (BMI) \>35 kg/m2. * Opioid dependency. * Cognitive impairment. * Bleeding or coagulation disorders. * Psychiatric and neurological disorder. * Local infection at the site of injection. * Severe heart, lung, liver, and renal dysfunction.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to the first request for the rescue analgesia | 24 hours postoperatively | Time to the first request for the rescue analgesia will be recorded from the end of surgery to first dose of morphine administrated. |
Secondary
| 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. |
| 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. |
| Quality of recovery | 24 hours postoperatively | The quality of recovery (QoR-15) score will be assessed 24 hours postoperatively. This tool consists of 15 questions, each scored on a 10-point scale, yielding a maximum of 150. It encompasses five domains; physical comfort (questions 1-4, 13), emotional state (questions 9, 10, 14, 15), psychological support (questions 6, 7), physical independence (questions 5, 8), and pain (questions 11, 12). |
| Incidence of adverse events | 24 hours postoperatively | Incidence of adverse events such as bradycardia, hypotension, nausea, vomiting, respiratory depression, pruritus, or any other complication will be recorded. |
Countries
Egypt
Contacts
CONTACTMohammed S Elsharkawy, MD
Outcome results
None listed