External Oblique Intercostal Block, Open Nephrectomy, Rhomboid Intercostal Sub-serratus Plane Block
Conditions
Brief summary
This study aims to compare time of first request of analgesia among patients undergoing rhomboid intercostal sub-serratus plane block versus external oblique intercostal block for perioperative pain management in open nephrectomy.
Detailed description
Open nephrectomy is a common surgery usually performed for malignant and non-malignant renal pathologies. Open nephrectomy incision is associated with a high incidence of intense immediate postoperative pain and chronic pain the months following surgery. The rhomboid intercostal block has previously been used for pain management in thoracic wall surgery. Subserratus plane block in the treatment of post-abdominal surgical pain and the combination of the two blocks was subsequently renamed the "RISS block". The nerves targeted by the RISS block include the lateral cutaneous branches of the ventral branches of the thoracic intercostal nerves, located between the rhomboid muscle and the intercostal muscles, and deep into the scapula serratus anterior muscle. RISS block provides analgesia from T4 to T9 thoracic dermatomes and has been used in postoperative pain management for thoracic surgeries and upper abdominal surgeries.
Interventions
Patients will receive the rhomboid intercostal subserratus plane block.
Patients will receive the external oblique intercostal block.
Patients will not receive any interventions (Intravenous morphine 0.1mg/kg after induction of general anesthesia).
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Both sexes. * American Society of Anesthesiologists (ASA) physical status II, III. * Body mass index (BMI): \> 20 kg/ m2 and \< 35 kg/ m2. * Patients undergoing open nephrectomy.
Exclusion criteria
* Patient refusal. * BMI \<20 kg/m2 and \>35 kg/m2 * Known sensitivity or contraindication to drug used in the study (local anesthetics, opioids). * History of psychiatric and cognitive disorders or chronic pain. * Contraindication to regional anesthesia e.g pre- existing peripheral neuropathies. * Severe respiratory or cardiac disorders. * Advanced liver or kidney disease. * Pregnancy. * Physical status ASA IV. * Coagulopathy with INR ≥ 1.6: hereditary (e.g. hemophilia, fibrinogen abnormalities \& deficiency of factor II) - acquired (e.g. impaired liver functions with prothrombin concentration less than 60 %, vitamin K deficiency \& therapeutic anticoagulants drugs).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time of first request of analgesia | 24 hours postoperatively | Time of first request of analgesia will be recorded from the end of surgery till first dose of morphine administrated. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Heart rate | 24 hours postoperatively | Heart rate will be noted immediately on arrival and at 0, 4, 8, 12, 18 and 24 h postoperatively. |
| Mean arterial blood pressure | 24 hours postoperatively | Mean arterial blood pressure will be noted immediately on arrival and at 0, 4, 8, 12, 18 and 24 h postoperatively. |
| Total amount of fentanyl | 24 hours postoperatively | Fentanyl 0.5 μg / kg will be given in case of heart rate or mean arterial blood pressure ≥ 20% of the baseline |
| Total morphine consumption | 24 hours postoperatively | Intravenous morphine (3 mg) will be provided as rescue of analgesia. The total amount of morphine given in 24 h will be recorded. |
| Degree of pain | 24 hours postoperatively | Each patient will be instructed about postoperative pain assessment with the numeric rating scale (NRS) score. NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). NRS will be recorded at 30 minutes, 2,4, 8, 12, 16, 24 hours postoperatively. |
| Incidence of block related complications | 24 hours postoperatively | Incidence of block related complications such as local anesthetic toxicity, hematoma formation, and pneumothorax will be recorded. |
Countries
Egypt
Contacts
CONTACTAmr R Seif, MD
Outcome results
None listed