The aim of this study to evaluate efficacy of ultrasound guided regional anesthesia in performing awake tympanoplasty surgery versus traditional general anesthesia
* To evaluate ultrasound-guided regional anesthesia versus general anesthesia in patients undergoing tympanoplasty as regards: * To assess the time of discharge from post anesthesia care unit * To assess intraoperative hemodynamic parameters, quality of the surgical field and the block success rate (number of patients converted to general anesthesia). * To assess postoperative parameters: Numerical Rating Scale , time to first request of analgesia, postoperative opioid consumption, patient and surgeon satisfaction in both groups. * To assess the incidence of block-related complications (such as nerve injury, hematoma, inadequate block, or local anesthetic toxicity) or surgery related complications as nausea and vomiting
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
128
patients will receive regional anesthesia using ultrasound guidance. Target nerves (e.g., great auricular nerve, auriculotemporal nerve and lesser occipital nerve) will be identified and anesthetized under real-time ultrasound visualization to ensure accurate needle placement and local anesthetic spread.
patients will receive general anesthesia.
faculty of human medicine, Zagazig university hospitals
Zagazig, Egypt
RECRUITINGThe time of discharge from Post Anesthesia Care Unit (PACU)
The time from arrival to the Post Anesthesia Care Unit (PACU) to the time to discharge to the ward according to modified aldrete score
Time frame: 2 hours postoperative
Intraoperative mean arterial blood pressure
Intraoperative changes in mean arterial blood pressure (mmHg)
Time frame: 0 minute (basal) and every 5 minutes up to 2 hours
Pain intensity by using Numerical Rating Scale (NRS)
It is a scale from 0 to 10, where 0=no pain and 10= worst pain
Time frame: Post Anesthesia Care Unit (0 hour) , 2 hours, 4 hours, 8 hours, 12 hours and 24 hours
Block success rate
The number of patients converted to general anesthesia
Time frame: 15-20 minutes (from finishing block till start surgery)
Quality of surgical field
quality of surgical field by Modena Bleeding Score (MBS) is a validated categorical scale designed to measure the quality of the surgical field in relation to bleeding during endoscopic surgery. It features five grades (1= no bleeding, 2= bleeding easily controlled by suction, 3= bleeding that slows surgical procedure, 4= most maneuvers are dedicated to bleeding control and 5= bleeding is so sever that only procedures aimed at controlling bleeding)
Time frame: duration of surgery (intraoperative)
Time to first request of analgesia
Time to first request of analgesia (pethidine)
Time frame: 24 hours
Total postoperative analgesic consumption
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total postoperative pethidine consumption
Time frame: 24 hours
Patient satisfaction by Likert score
patient satisfaction by Likert score: The patients will be asked to rate the overall degree of satisfaction of the analgesia by using a 5-points Likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia)
Time frame: 24 hours
Surgeon satisfaction
Surgeon satisfaction by asking the surgeon to rate satisfaction at the end of surgery (4 =excellent, 3=good, 2=fair, 1=poor, 0=extremely poor)
Time frame: duration of surgery (intraoperative)
The incidence of block-related complications or surgery related complications
To assess the incidence of block-related complications, such as nerve injury, hematoma, inadequate block, or local anesthetic toxicity or surgery related complications (e.g. nausea and vomiting)
Time frame: 24 hours
Intraoperative heart rate ( beat per minute)
measure intraoperative changes in heart rate
Time frame: before starting anesthesia 0 minute (basal )and every 5 minutes up to 2 hours