This study aims to compare the ultrasound-guided edge of laminar block (ELB) and erector spinae plane block (ESPB) for postoperative analgesia in patients undergoing video-assisted thoracic surgery (VATS).
Postoperative pain after thoracic surgery, which is attributed to muscle incisions, rib retractions, and intercostal nerve damage, may be severe enough to cause pulmonary complications, such as atelectasis, pneumonia, and increased oxygen consumption. The erector spinae plane block (ESPB) is used for managing post-thoracotomy pain and has numerous advantages that make it an attractive alternative technique. The ESPB injects a local anaesthetic around the erector spinae muscle at approximately the level of the T5. It may be able to block the dorsal and ventral rami of the thoracic spinal nerves. A novel technique of retrolaminar block (RLB) called the edge of laminar block (ELB) to provide sensory analgesia during rib fracture surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
70
Patients will receive edge of laminar block using 20ml of bupivacaine 0.25%.
Patients will receive an erector spinae plane block using 20ml of bupivacaine 0.25%.
Tanta University
Tanta, El-Gharbia, Egypt
RECRUITINGTotal morphine consumption
Rescue analgesia of morphine will be given as 3 mg bolus if the numeric rating scale (NRS)\> 3 to be repeated after 30 min if pain persists until the NRS \< 4.
Time frame: 24 hours postoperatively
Time to the 1st rescue analgesia
Time to the first request for the rescue analgesia (time from the end of surgery to first dose of morphine administrated).
Time frame: 24 hours postoperatively
Intraoperative fentanyl consumption
Additional fentanyl bolus dosages of 0.5 µg/kg IV will be administered if heart rate or mean arterial blood pressure elevated more than 20% of the baseline.
Time frame: Intraoperatively
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 performing of block, and every 15 min till the end of surgery.
Time frame: Till the end of surgery (Up to 2 hours)
Degree of pain
Each patient will be instructed about postoperative pain assessment with the numeric rating scale (NRS). NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). NRS will be assessed at post-anesthesia care unit (PACU), 2, 4, 6, 8, 12, 18, and 24 h postoperatively.
Time frame: 24 hours postoperatively
Incidence of adverse events
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Incidence of adverse events such as bradycardia, hypotension, nausea, vomiting, respiratory depression, pruritus, urinary retention, itching, constipation, or any other complication.
Time frame: 24 hours postoperatively