Postoperative Pain, Acute
Conditions
Keywords
TAP Block, ESP Block
Brief summary
The goal of this study is to compare the analgesic efficacy of ultrasound-guided transversus abdominis plane (TAP) block versus erector spinae plane block (ESPB) in adult patients undergoing laparoscopic renal surgeries. Forty adults (18-60 years, ASA I-II) will be randomly assigned to receive either TAP or ESPB after induction of general anesthesia. Postoperative pain will be assessed using the Visual Analogue Scale (VAS) and total fentanyl consumption over 24 hours. Secondary outcomes include time to first analgesic request, hemodynamic parameters, patient satisfaction, and incidence of complications. The study will be conducted at Cairo University Hospitals following ethical approval, with all patients providing written informed consent.
Detailed description
This randomized controlled trial aims to compare the analgesic efficacy of ultrasound-guided transversus abdominis plane (TAP) block versus erector spinae plane block (ESPB) in adult patients undergoing laparoscopic renal surgeries. Forty adults (18-60 years, ASA I-II) will be randomly assigned to receive either TAP or ESPB after induction of general anesthesia. Preoperative assessment will include medical and surgical history, clinical examination, and routine laboratory investigations. Intraoperative management will follow standard monitoring with general anesthesia, and the block will be performed under ultrasound guidance using 0.25% bupivacaine, bilaterally. TAP block will be performed at the anterolateral abdominal wall, while ESPB will be performed at the T8-T9 level in lateral decubitus position. The anesthesiologist performing the block will not participate in postoperative data collection, and outcome assessors will be blinded. Postoperative pain management includes IV paracetamol every 8 hours and rescue fentanyl boluses (25 μg IV) if VAS ≥4, with a maximum total dose of 0.2-0.4 mg in 24 hours. Pain will be measured using the Visual Analogue Scale (VAS) at PACU, 2, 4, 6, 12, 18, and 24 hours. Secondary outcomes include time to first analgesic request, hemodynamic parameters, patient satisfaction, and incidence of adverse events such as PONV, hypotension, bradycardia, urinary retention, LAST, pneumothorax, or failed block. Primary outcome: total fentanyl consumption in the first 24 hours postoperatively. Secondary outcomes: time to first rescue analgesia, VAS scores, hemodynamic stability, patient satisfaction, and complications. The study will be conducted at Cairo University Hospitals after ethical committee approval, with all patients providing written informed consent. Data will be analyzed using SPSS v26, with parametric and non-parametric tests, repeated-measures ANOVA for VAS over time, Kaplan-Meier analysis for time to rescue analgesia, and chi-square or Fisher's exact test for categorical outcomes.
Interventions
PROCEDURETAP Block
a bilateral ultrasound guided TAP block performed by injecting 20 ml of 0.25% bupivacaine into the TAP space after negative aspiration. a bilateral ultrasound guided ESP block performed by injecting 20 ml of 0.25% bupivacaine into the ESP space after negative aspiration.
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 40 Years
Healthy volunteers
No
Inclusion criteria
* Age from 18 to 40 years old. * Both sexes. * American Society of Anesthesiology (ASA) physical status I, II. * Scheduled for laparoscopic renal surgeries under general anesthesia
Exclusion criteria
* Parent's refusal. * Coagulation disorders. * History of allergy to local anesthetics. * Infection or redness at the injection site. * History of renal and/or hepatic insufficiency. * Preexisting cardiac dysfunction.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total fentanyl consumption. | 24 hours. | Total fentanyl consumption in the first 24 hours (μg-microgram) postoperative. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to first rescue analgesia. | 24 hours postoperatively. | Time elapsed from the end of surgery until the patient requires the first dose of rescue analgesia. |
| Postoperative Pain scores. | At Post Anesthesia Care Unit (PACU) and 2,4,6,12,18,24 hours Postoperatively. | pain assessment using Visual Analog Scale (VAS) score: pain level scored from 0 (no pain) to 10 (worst imaginable pain). |
| Hemodynamic Parameter Heart rate | At PACU and 1,2,4,6,12,24 hours postoperatively. | Heart rate |
| Hemodynamic Parameter | At PACU and 1,2,4,6,12,24 hours postoperatively. | mean arterial blood pressure |
| Hemodynamic Parameter oxygen saturation | At PACU and 1,2,4,6,12,24 hours postoperatively. | oxygen saturation |
| Patient Satisfaction. | 24 hours postoperatively. | Degree of patients' satisfaction. |
| Incidence of postoperative complications. | within 24 hours postoperatively. | Incidence of complications as hypotension, bradycardia, respiratory depression, pneumothorax and urine retention. |
Countries
Egypt
Contacts
CONTACTHala ElSabbagh, M.D.
PRINCIPAL_INVESTIGATORHala ElSabbagh, M.D.
Cairo University
Outcome results
None listed