Analgesic Efficacy of Adding Dexmedetomidine to Erector Spinae Plane Block Versus Subcostal Transverse Abdominis Plane Block in Laparoscopic Cholecystectomy

Kafrelsheikh University40 enrolled

Overview

Our scientific work aimed to evaluate the analgesic efficacy of dexmedetomidine as an adjuvant to erector spinae plane block versus subcostal transverse abdominis plane block in patients undergoing laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) is the most commonly performed surgical procedure for the management of cholelithiasis. Acute pain after LC consists of somatic, parietal, and referred pain caused by trocar insertion, gall bladder resection, carbon dioxide insufflation, and other factors. The subcostal transverse abdominis plane (SCTAP) block is the deposition of local anesthetic in the transverse abdominis plane inferior and parallel to the costal margin. Ultrasound-guided erector spinae plane block (ESPB) is a popular, interfascial regional technique initially described for managing thoracic neuropathic pain. Dexmedetomidine is an alpha-2 adrenergic receptor agonist that has been the focus of interest due to its sedative, analgesic, perioperative sympatholytic, and cardiovascular-stabilizing effects, resulting in reduced anesthetic requirements.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Analgesic Efficacy Dexmedetomidine

Interventions

Subcostal transverse abdominis plane blockOTHER

Patients received an ultrasound-guided subcostal transverse abdominis plane block with injection of 10 ml bupivacaine 0.25 %, 5ml lignocaine 2 % plus 0.5 μg/kg dexmedetomidine in a 20 ml volume.

Erector spinae plane blockOTHER

Patients will receive an ultrasound-guided erector spinae plane block (ESPB) with injection of 10 ml bupivacaine 0.25%, 5 ml lignocaine 2 % plus 0.5 μg/kg dexmedetomidine in a 20 ml volume.

Eligibility

Sex: ALLMin age: 20 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age from 20 to 60 years. * Both sexes. * American Society of Anesthesiologists (ASA) physical status I and II. * Patients were planned to undergo laparoscopic cholecystectomy. Exclusion Criteria: * Patient's refusal to participate in the study. * ASA III, IV. * History of clinically significant cardiac, hepatic, renal, respiratory or neurological disease. * Coagulopathy and bleeding disorders. * Known allergy to any drug included in the study. * Systemic or local infection at the puncture site. * Body mass index (BMI) \>35 (kg/m2). * Failed technique.

Outcomes

Primary Outcomes

Total dose of morphine consumption

If the Visual analogue scale (VAS) is ≥ 3, IV morphine was given as a bolus of 2 mg (body weight \< or = 60 kg) or 3 mg (body weight \> 60 kg) with 5 minutes' lockout interval.