Comparing the impact of bilateral erector spinae plane block and transverse abdominis plane block on improving quality of pain management after umbilical hernia repair.
Postoperative pain is an important problem after umbilical hernia repair which has negative effects on patient's hemodynamics and cause delayed ambulation resulting in prolonged duration of hospital stay and poor patient satisfaction. Multiple analgesic strategies have been proposed including Non steroidal anti-inflammatory drugs (NSAIDs), opioids, epidural analgesia. Each of them has its limitations. Ultra¬sound guided regional anesthesia techniques for abdominal wall can be effective components of multimodal postoperative analgesia with limited side-effects Erector spinae plane (ESP) block is a promising para-spinal bock that can achieve both visceral and somatic abdominal analgesia if the injection was performed at a lower thoracic level. Transverse abdominis plane (TAP) block which is considered a peripheral nerve block that is aimed at anesthetizing nerves supplying the anterior abdominal wall. We will compare between erector spinae plane block and transverse abdominis plane block for controlling postoperative pain after umbilical hernia repair. Patients will be allocated randomly into two equal groups by a computer-generated randomization table Group (E) (n=26): Patients will receive erector spinae plane (ESP) block after completion of surgery. Group (T) (n= 26): Patients will receive oblique subcostal transverse abdominis plane (TAP) block after completion of surgery
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
52
Using the in plane technique, the needle will be advanced between the transverse process and erector spinae muscle. The correct location will be confirmed using 1ml of Local Anesthetic (LA) to view hydrodissection(12). 19ml of LA will be injected between the muscle and transverse process.
An echogenic needle will be inserted in-plane until the needle tip reaches the fascia between the rectus abdominis and the transverse abdominis muscles. Once the needle enters the TAP plane, a dynamic injection can be performed by advancing the needle under ultrasound guidance laterally in the pocket created by the initial injection of 5 - 10 mL of local anesthetic; as the needle is advanced, the remaining local anesthetic will be injected. This allows for a more lateral spread of the local anesthetic
Zagazig University hospital
Zagazig, Sharqia Province, Egypt
RECRUITINGPostoperative analgesic requirements
measuring the total doses of analgesic required to relieve the pain
Time frame: 24 hours postoperative
Postoperative pain severity using Visual Analogue scale
assessing pain severity using Visual Analogue scale (VAS) (0-100mm)
Time frame: 24 hours postoperative
Postoperative pain severity using Verbal Rating Scale
assessing pain severity using Verbal Rating Scale (mild, moderate and severe)
Time frame: 24 hours postoperative
Postoperative pain severity using Numeric Rating Scale
assessing pain severity using Numeric Rating Scale (NRS) (0-10; 0, no pain; 10, worst pain)
Time frame: 24 hours postoperative
Postoperative heart rate changes
monitoring postoperative changes in the heart rate (HR) measured by beat per minute (BPM) and comparing it with the preoperative measures
Time frame: 24 hours postoperative
Postoperative blood pressure changes
monitoring postoperative changes in the blood pressure (BP) measured by mm Hg and comparing it with the preoperative measures.
Time frame: 24 hours postoperative
Incidence of postoperative side effects
recording any postoperative complications as nausea and vomiting
Time frame: 24 hours postoperative
Duration of postoperative hospital stay
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measuring the delay in discharging the patients postoperative because of the pain
Time frame: 24 hours postoperative