Abdominoplasty, Analgesic Technique, Modified Thoracoabdominal Nerve Block (M-TAPA), Thoracic Erector Spinae Plane Block
Conditions
Brief summary
This study aimed to compare the analgesic effect of bilateral ultrasound-guided modified thoracoabdominal nerve block with bilateral ultrasound-guided erector spinae plane block in abdominoplasty surgery.
Detailed description
Abdominoplasty is an extra-peritoneal surgery devoid of visceroperitoneal component of pain, most of pain is initially related to the abdominal wall's facial plication in addition to pain generated from the abdominal wall incision. Ultrasound guided erector spinae plane block (ESPB) is considered relative an effective block that can be used to provide postoperative analgesia in abdominoplasty (Tulgar et al., 2018). Erector spinae plane block (ESPB) is an interfascial plane block was used to relieve chest neuropathic pain. The modified thoracoabdominal nerve block through the perichondral approach (M-TAPA) is a novel regional nerve block that can provide optimal analgesia for both the lateral and anterior abdominal wall. It can provide wide range of analgesic coverage of the trunk (i.e., T7-T12) by a single puncture per side and has been initially reported to provide a longacting analgesia.
Interventions
DRUGGeneral Anaesthesia using intravenous propofol, fentanyl intravenous, and atracurium besylate
Patients received only standard general anesthesia using intravenous propofol (2-3 mg/kg), fentanyl intravenous (1.5µ/kg) and atracurium besylate (0.6 mg/kg).
DRUGModified thoracoabdominal nerve block using 25 mL of bupivacaine 0.25%
Patients received modified thoracoabdominal nerve block bilaterally using 25 mL of bupivacaine 0.25% and a lidocaine mixture (15 mL of bupivacaine 0.5% plus 5 mL of 2% lidocaine).
DRUGErector spinae plane block using 25 mL of bupivacaine 0.25%
Patients receive erector spinae plane block bilaterally using 25 mL of bupivacaine 0.25% and a lidocaine mixture (15 mL of bupivacaine 0.5% plus 5 mL of 2% lidocaine).
Sponsors
Mansoura University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Age between 21 and 60 years. * Both sexes. * American Society of Anesthesiologists physical status grade I and grade II. * Elective abdominoplasty operation.
Exclusion criteria
* Patient refusal. * Local skin infection and sepsis at site of the block. * Known allergy to local anesthetic drugs. * Coagulopathy. * Psychiatric diseases. * Central or peripheral neurological disease.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total opioid consumption | 24 hours postoperatively | Intravenous pethidine (0.5mg/kg) was taken every 12 hours as rescue analgesia. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of analgesia | 24 hours postoperatively | Duration of analgesia was recorded from the end of surgery till the first dose of pethidine administered. |
| Degree of pain | 24 hours postoperatively | A postoperative numeric rating scale (NRS) was employed to assess patients' postoperative pain levels. It is scored from 0 to 10 (0 meaning no pain and 10 meaning the worst pain). NRS was assessed at 0, 6, 12, and 24 hr postoperative. |
| Cortisol level | 24 hours postoperatively | Cortisol level was recorded at basal, 8 hr, and 24 hr postoperative. |
| C-reactive protein (CRP) level | 24 hours postoperatively | The C-reactive protein (CRP) level was recorded at basal, 8 hr, and 24 hr postoperatively. |
| Incidence of complications | 24 hours postoperatively | Incidence of complications such as nausea, vomiting, pruritus, and respiratory depression were recorded. |
Countries
Egypt
Outcome results
None listed