This study compares the transversus thoracic muscle plane block (TTPB), midtransverse to pleura block (MTPB), and erector spinae plane block (ESPB) for postoperative analgesia in patients undergoing thoracoscopic sympathectomy.
Thoracoscopic sympathectomy is a well-established procedure for the treatment of various hyperhidrosis disorders and certain vascular conditions, involving the division of sympathetic nerve fibers in the thoracic cavity. The erector spinae plane block (ESPB) is an interfascial regional anesthesia block for thoracic analgesia which can be performed by superficial or deep needle approach. The mid-transverse to pleura block (MTPB) was first described as a modified paravertebral block. Transversus thoracic muscle plane block (TTPB) is a newly developed technique in which LA is injected into the fascial plane between the transversus thoracic muscle and the internal intercostal muscles for blocking the anterior cutaneous branches of intercostal nerves from thoracic (Th) 2 to Th 6.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
60
Patients will receive a transverse thoracic plane block.
Patients will receive a midpoint transverse process plane to pleura block.
Patients will receive an erector spinae plane block.
Tanta University
Tanta, El-Gharbia, Egypt
Time to the 1st rescue analgesia
Time to the first request for the rescue analgesia (time from end of surgery to first dose of morphine administrated)
Time frame: 24 hours postoperatively
Total morphine consumption
Rescue analgesia of morphine will be given as 3 mg bolus if the Visual Analogue Scale (VAS)\> 3 to be repeated after 30 min if pain persists until the VAS \< 4
Time frame: 24 hours postoperatively
Degree of pain
Each patient will be instructed about postoperative pain assessment with the Visual Analogue Scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS will be assessed at 0, 4, 8, 12, 18 and 24h postoperatively.
Time frame: 24 hours postoperatively
Heart rate
Heart rate will be recorded preoperatively, before performing of block, and every 15 min till the end of surgery.
Time frame: Till the end of surgery (Up to 2 hours)
Mean arterial pressure
Mean arterial pressure will be recorded preoperatively, before the block is performed, and every 15 minutes until the end of the surgery.
Time frame: Till the end of surgery (Up to 2 hours)
Degree of patient satisfaction
Degree of patient satisfaction will be assessed on a 5-point Likert scale patient satisfaction (1, extremely dissatisfied; 2, unsatisfied; 3, neutral; 4, satisfied; 5, extremely satisfied)
Time frame: 24 hours postoperatively
Incidence of complications
Incidence of complications such as pneumothorax, bradycardia, hypotension, nausea, vomiting, pruritis, respiratory depression, or any other complication will be recorded.
Time frame: 24 hours postoperatively
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