evaluate and compare the impact of ultrasound guided rhomboid intercostal block versus serratus anterior plane block for analgesia after thoracodorsal artery perforator flap following partial mastectomy
* To assess and compare quality of post- operative analgesia in each group. * Time of performance of block in both groups. * To assess and compare post-operative hemodynamics as well as anticipated adverse effects including nausea, vomiting, itching, hemorrhage, bradycardia, hypotension.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
84
general anesthesia
the patients will be positioned in lateral decubitus with moving the scapula laterally by abducting the ipsilateral arm across the chest. under complete aseptic situations A high-frequency (6-12 MHz) linear US probe will be put medial to the medial border of the scapula in an oblique sagittal plane with the orientation marker directed cranially.at the T6-7 level, the tissue plain between the rhomboid major and intercostal muscles is identified, and a single injection of 25mL of bupivacaine (0.25%) will be administered via 18-gauge Tuohy advanced in plane from a superomedial to an inferolateral direction, followed by general anesthesia
Heba M Fathi
Zagazig, Egypt
RECRUITINGtramadol consumption
The amount of tramadol consumption
Time frame: at 24 hours postoperative
Time of performance of block
Time needed to performance the block
Time frame: time from positioning of ultrasound porbe till the end of block procedure.
Time to first dose of rescue analgesia
the first time that the patients need analgesia when VAS ≥ 3
Time frame: during the first 24 hours postoperatively
Anticipated side effect
nausea, vomiting, local anesthesia toxicity, needle injury
Time frame: at 24 hous post operative
Post operative patient's satisfaction
Post operative patient's satisfaction using 3 point scale (1= satisfied ,2=neutral, 3=not satisfied)
Time frame: at 24 hours post operative
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The patient will be positioned supine with his arm abducts at 90°. the US high frequency (6-12 MHz) linear probe of sonosite M turbo ultrasonography (FUJIFIM sonosite, Inc., Bothell, WA, USA) will be put in sagittal plane at the midaxillary line. identification of the fascial plane between the serratus anterior muscle and external intercostal muscles will be performed between the fourth and fifth ribs in the midaxillary area . At this point the18-gauge Tuohy needle will be advanced in plane with injection of 25mL of 0.25 %, bupivacaine. followed by general anesthesia