Ultrasound Guided Rhomboid Intercostal Subserratus Plane Block vs Erector Spinae Plane Block in Open Nephrectomy

N/ACompletedNCT05822011

Cairo University42 enrolled

Overview

Our aim is to measure the efficacy of rhomboid intercostal subserratus plane block and erector spinae plane block in patients undergoing open nephrectomy

Open nephrectomy incision is associated with a high incidence of intense immediate postoperative pain and chronic pain the months following surgery. Regional anesthesia techniques are commonly recommended for pain management in open nephrectomy as they decrease parenteral opioid requirements and improve patient satisfaction. Rhomboid intercostal subserratus plane block (RISS) is considered a novel approach for chest wall and upper abdominal analgesia, initially showed promising results, first reported in 2016. Erector Spinae Plane block (ESB), was initially described in 2016 for analgesia in thoracic neuropathic pain. It has also been widely used in both adults and children at different levels for different indications. Epidural analgesia is the gold standard for perioperative analgesia in open surgery.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Post Operative Pain

Interventions

Rhomboid intercostal subserratus plane blockPROCEDURE

Fascial plane block

Erector spinae plane blockPROCEDURE

Fascial plane block

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Type of surgery; open nephrectomy. 2. Physical status ASA II, III. 3. Body mass index (BMI): \> 20 kg/ m2 and \< 35 kg/ m2. Exclusion Criteria: 1. Patient refusal. 2. Local infection at the puncture site. 3. Severe respiratory or cardiac disorders. 4. Advanced liver or kidney disease. 5. History of psychological disorders and/or chronic pain. 6. Contraindication to regional anesthesia e.g. local sepsis, pre- existing peripheral neuropathies and coagulopathy. 7. Patients with known sensitivity or contraindication to amide local anesthetics used in the study.

Locations (1)

National Cancer Institute

Cairo, Egypt

Outcomes

Primary Outcomes

The total amount of morphine consumption in (mg)

amount of morphine in mg consumed in 1st 24 hours

Time frame: first 24 hours postoperatively.

Secondary Outcomes

Time of first request of analgesia

calculated from the time of complete injection of local anesthetics till the numerical pain rating scale (NRS) is ≥3.(NRS requires the patient to rate their pain on a defined scale. For example, 0-10 where 0 is no pain and 10 is the worst pain imaginable)

Time frame: first 24 hours postoperatively

Total amount fentanyl in (microgram)

total amount of intraoperative fentanyl consumed in micrograms

Time frame: intra operative duration

Change in heart rate in (beat/min)

Readings will be taken as baseline preoperative reading, immediately after surgical incision and at 15-minute intervals intraoperatively and 30 minutes,2,4,8,12,16 and 24 hours postoperatively

Time frame: From just before induction till 24 hours post operatively

Change in mean arterial blood pressure in (mmHg)

Readings will be taken as baseline preoperative reading, immediately after surgical incision and at 15-minute intervals intraoperatively and 30 minutes,2,4,8,12,16 and 24 hours postoperatively

Time frame: From just before induction till 24 hours post operatively

Numeric Pain Rating Scale

A numerical rating scale (NRS) requires the patient to rate their pain on a defined scale. For example, 0-10 where 0 is no pain and 10 is the worst pain imaginable

Time frame: first 24 hours postoperatively

Data from ClinicalTrials.gov

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