Ultrasound-guided Erector Spinae Plane Block Versus Retrolaminar Block for Postoperative Analgesia in Thoracotomy

Tanta University60 enrolled

Overview

Comparing efficacy of Ultrasound-guided Erector Spinae Plane Block versus Retrolaminar Block for Postoperative Analgesia in Patients Undergoing Thoracotomy

Thoracotomy is one of the most painful surgical procedures. The reported incidence of persistent pain after thoracic surgery (post thoracotomy pain syndrome) has been reported in 20%-70% of patients. Inadequately treated post thoracotomy pain can have several negative consequences. Therefore, pain relief is essential to facilitate coughing and deep breathing and to promote early mobilization. Thoracic epidural analgesia and thoracic paravertebral block are strongly recommended techniques for managing post thoracotomy pain to reduce opioid use and the related adverse effects as hypoventilation, depression of cough reflex, nausea and vomiting. However, they can be technically challenging to perform and are associated with up to 15% failure rate in Thoracic epidural analgesia and potential risk of pneumothorax in thoracic paravertebral block. Erector spinae plane block is a relatively novel ultrasound-guided regional technique. Its application in patients with chronic thoracic neuropathic pain and acute surgical pain has been described by Forero et al. Retrolaminar block is an easy and safe analgesic technique. It has been reported to be satisfactory for post-operative analgesia after breast surgery. To our knowledge there is no clinical studies, comparing the effectiveness of both blocks on postthoracotomy pain, has been reported.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Postoperative Analgesia Retrolaminar Block Ultrasound-guided Erector Spinae Plane Block Thoracotomy

Interventions

Ultrasound-guided Erector Spinae Plane BlockPROCEDURE

ultrasound-guided ipsilateral Erector Spinae Plane Block (20 ml (19ml bupivacaine 0.25% plus 1ml dexamethasone 4mg)).

Retrolaminar BlockPROCEDURE

ultrasound-guided ipsilateral Retrolaminar Block (20 ml (19ml bupivacaine 0.25% plus 1ml dexamethasone 4mg)).

ControlPROCEDURE

General anesthesia

Eligibility

Sex: ALLMin age: 21 YearsMax age: 65 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Adult patients aged 21-65 years old of both sexes. * Patients were scheduled for elective thoracotomy. * Their ASA physical status classification is II-III. Exclusion Criteria: * Patients' refusal. * Local infection at the site of block. * Coagulation abnormalities. * Sever spinal deformity e.g. scoliosis. * Known hypersensitivity to local anesthetics. * Mental dysfunction and cognitive disorders. * History of drug abuse and chronic analgesic use.

Locations (1)

Tanta University

Tanta, Gharbia Governorate, Egypt

Outcomes

Primary Outcomes

Pain assessment

The Numeric Pain Rating Scale is a valid and simple approach to pain assessment (0= no pain and 10= worst possible pain). Postoperative pain will be assessed at emergence and 2nd, 4th, 8th, 12th, 18th and 24th hour postoperatively.

Time frame: 24 hours postoperatively.

Secondary Outcomes

The time of first analgesic request

The time of first analgesic request. IV morphine sulphate 0.05 mg/kg will be administered as rescue analgesic if Numeric Pain Rating Scale is ≥ 4.

Time frame: 24 hours postoperatively

The total amount of morphine

The total amount of morphine consumption in the first 24 hours postoperatively.

Time frame: 24 hours postoperatively

Data from ClinicalTrials.gov

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