Colorectal cancer is the third most common cancer worldwide. These patients usually undergo open surgical resection of cancer under general anaesthesia. The aim of this study is to detect whether the Erector spinae plan block or Quadratus lumborum block will provide the most ideal analgesia for these patients. Erector spinae plan block is a novel analgesic technique that provides both visceral and somatic analgesia due to its communication with the paravertebral space. Quadratus lumborum block is a truncal nerve block usually used for intra-abdominal surgeries. Ultrasound guidance increases the accuracy and safety of both techniques. A local anaesthetic mixture of Bupivacaine 0.25% and dexamethasone will be used for both techniques.
Erector spinae plane block and quadratus lumborum block are analgesic techniques suitable for open colorectal cancer surgeries. postoperative pain score, serum levels of biomarkers of stress (cortisol and CRP), primary hemodynamics, time to first rescue analgesic request, the total amount of rescue analgesic consumption and postoperative nausea and vomiting are the parameters of comparison between both techniques.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
68
For each side, the eighth thoracic transverse process will be identified by a linear US transducer (HFL38\_10-5 MHz), puncture will be performed in the plane in the craniocaudal direction until the needle contacts the transverse process, and 20 ml of bupivacaine 0.25% and 4 mg dexamethasone will be injected visualizing the hydrodissection. After 30 minutes, the degree of sensory block in the trunk will be assessed by the pinprick test and any undesirable motor weakness will be recorded as a side effect.
For each side, shamrock sign with three leaves (psoas major muscle anteriorly, the erector spinae muscle posteriorly and the quadratus lumborum muscle adherent to the apex of the transverse process of the L4 vertebral body) will be identified by a curved array US transducer (6-2MHz), puncture will be performed in-plane, the needle will be advanced through the quadratus lumborum muscle penetrating the ventral proper fascia of the quadratus lumborum muscle, and 20 mL of bupivacaine 0.25% and 4 mg dexamethasone will be injected in that space visualizing the hydrodissection. After 30 minutes, the degree of sensory block in the trunk will be assessed by the pinprick test and any undesired motor weakness will be recorded as a side effect
Propofol (2 mg/kg)
Fentanyl (1µg/Kg)
atracurium (0.5mg/kg)
endotracheal intubation
Inhalational isoflurane in oxygen/air mixture
atracurium boluses (0.2 mg/Kg/20 minutes) will be used for maintenance of general anesthesia
Amer A Attieh
Al Mansurah, DK, Egypt
Postoperative pain score
The intensity of pain indicated by a segmented numeric scale in which a respondent selects a whole number (0-100 integers) that best reflects his/her pain as 0-30 for mild pain, 30-60 for moderate pain and 60-100 for sever pain
Time frame: From 1 day before the surgery to the 2 days after surgery
Systolic Blood Pressure
The pressure in the arteries during contraction of the heart
Time frame: One hour before induction of general anesthesia, every 10 minutes till end of surgery, every 4 hours till end of the first 24 hours postoperatively, then every 8 hours till end of the next 24 hours
Mean Blood Pressure
: The average pressure in the arteries during one cardiac cycle. It is a better indicator for vital organs' perfusion than the systolic pressure
Time frame: One hour before induction of general anesthesia, every 10 minutes till end of surgery, every 4 hours till end of the first 24 hours postoperatively, then every 8 hours till end of the next 24 hours
Heart rate
The number of heart beats per minute. A lower heart rate at rest implies a more efficient heart function, better cardiovascular fitness and less stress
Time frame: One hour before induction of general anesthesia, every 10 minutes till end of surgery, every 4 hours till end of the first 24 hours postoperatively, then every 8 hours till end of the next 24 hours
Time to first rescue analgesic request
The time elapsed from termination of performing each block till the patient's request for analgesia. It resembles the duration of analgesia
Time frame: Up to 48 postoperative hours
Peripheral oxygen saturation
An estimate of oxygenated hemoglobin concentration in blood. It is measured by pulse oximeter device
Time frame: One hour before induction of general anesthesia, every 10 minutes till end of surgery, every 4 hours till end of the first 24 hours postoperatively, then every 8 hours till end of the next 24 hours
Total amount of rescue analgesic consumption
The total amount of morphine consumed by the patient for pain relief over the 48 hours postoperatively
Time frame: From the time of first analgesic request till the end of the first 24 hours, then till the end of the next 24 hours postoperatively
Postoperative nausea and vomiting intensity score
Postoperative Nausea and Vomiting Intensity Scale: A scale that evaluates postoperative nausea and vomiting. It equals severity of nausea (1=mild, 2= moderate, 3= sever) x pattern of nausea (1=varying, 2= constant) x duration of nausea (in hours). At any time, if it is \< 50 or vomiting occurs once or twice, it is clinically unimportant (good outcome). If it is ≥50 or vomiting occurs 3 or more times, it is clinically important (bad outcome). The sum of all values will quantify the entire period of the study.
Time frame: Immediately after recovery, every 4 hours till end of the first 24 hours postoperatively, then every 8 hours till end of the next 24 hours
Cortisol
A steroid hormone secreted by adrenal cortex in response to stress and hypoglycemia
Time frame: At 9 Am, 1 hour after induction of general anesthesia, 1st, 24th and 48th hours postoperatively
Serum C-reactive protein (CRP)
A protein synthetized by hepatocytes in response to systemic inflammation or tissue damage
Time frame: On hospital admission, 1 hour after induction of general anesthesia, 1st, 24th and 48th hours postoperatively
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