This study aims to compare time of first request of analgesia among patients undergoing rhomboid intercostal sub-serratus plane block versus external oblique intercostal block for perioperative pain management in open nephrectomy.
Open nephrectomy is a common surgery usually performed for malignant and non-malignant renal pathologies. Open nephrectomy incision is associated with a high incidence of intense immediate postoperative pain and chronic pain the months following surgery. The rhomboid intercostal block has previously been used for pain management in thoracic wall surgery. Subserratus plane block in the treatment of post-abdominal surgical pain and the combination of the two blocks was subsequently renamed the "RISS block". The nerves targeted by the RISS block include the lateral cutaneous branches of the ventral branches of the thoracic intercostal nerves, located between the rhomboid muscle and the intercostal muscles, and deep into the scapula serratus anterior muscle. RISS block provides analgesia from T4 to T9 thoracic dermatomes and has been used in postoperative pain management for thoracic surgeries and upper abdominal surgeries.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
90
Patients will receive the rhomboid intercostal subserratus plane block.
Patients will receive the external oblique intercostal block.
Patients will not receive any interventions (Intravenous morphine 0.1mg/kg after induction of general anesthesia).
Cairo University
Cairo, Egypt
RECRUITINGTime of first request of analgesia
Time of first request of analgesia will be recorded from the end of surgery till first dose of morphine administrated.
Time frame: 24 hours postoperatively
Heart rate
Heart rate will be noted immediately on arrival and at 0, 4, 8, 12, 18 and 24 h postoperatively.
Time frame: 24 hours postoperatively
Mean arterial blood pressure
Mean arterial blood pressure will be noted immediately on arrival and at 0, 4, 8, 12, 18 and 24 h postoperatively.
Time frame: 24 hours postoperatively
Total amount of fentanyl
Fentanyl 0.5 μg / kg will be given in case of heart rate or mean arterial blood pressure ≥ 20% of the baseline
Time frame: 24 hours postoperatively
Total morphine consumption
Intravenous morphine (3 mg) will be provided as rescue of analgesia. The total amount of morphine given in 24 h will be recorded.
Time frame: 24 hours postoperatively
Degree of pain
Each patient will be instructed about postoperative pain assessment with the numeric rating scale (NRS) score. NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). NRS will be recorded at 30 minutes, 2,4, 8, 12, 16, 24 hours postoperatively.
Time frame: 24 hours postoperatively
Incidence of block related complications
Incidence of block related complications such as local anesthetic toxicity, hematoma formation, and pneumothorax will be recorded.
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Time frame: 24 hours postoperatively