Erector Spina Plane Block Versus Deep Serratus Anterior Plane Block for Post Mastectomy Analgesia
Nyckelord
Abstrakt
Beskrivning
Experimental: erector spinae plain block After giving general anesthesia, patient is positioned in lateral decubitus with the surgical side up, and prepping para-spinous area with antiseptic solution. Ultrasound high frequency linear transducer is positioned in a para-sagittal plane at the level of fifth thoracic vertebra. Scanning of interested structures from superficial to deep planes, Trapezius muscle, Rhomboid major muscle, Erector spina muscle and transverse process of fifth thoracic vertebra.
Comparator: serratus anterior plane block After giving general anesthesia, patient is positioned in lateral decubitus, with the surgical side up. The upper arm is abducted and elevated above the head level. Under sterile aseptic technique, a linear ultrasound transducer (6-15 MHz) is placed in a sagittal oblique plane over the fourth and fifth ribs at the mid-axillary line. The following muscles are identified overlying the fourth/ fifth rib: the latissimus dorsi (superficial) and serratus anterior muscle (deep) overlying the ribs.
Datum
| Senast verifierad: | 01/31/2020 |
| Först skickat: | 07/06/2019 |
| Beräknad anmälan inlämnad: | 09/26/2019 |
| Först publicerad: | 09/29/2019 |
| Senaste uppdatering skickad: | 02/28/2020 |
| Senaste uppdatering publicerad: | 03/02/2020 |
| Faktiskt startdatum för studien: | 07/06/2019 |
| Uppskattat primärt slutdatum: | 02/01/2020 |
| Beräknat slutfört datum: | 02/25/2020 |
Tillstånd eller sjukdom
Intervention / behandling
Procedure: ESPB GROUP
Procedure: SAPB group
Fas
Armgrupper
| Ärm | Intervention / behandling |
|---|---|
| Active Comparator: ESPB GROUP Erector spina plane block group | Procedure: ESPB GROUP After giving general anesthesia, patient is positioned in lateral decubitus with the surgical side up, An erector Spina plain block is performed with inserting block needle (Pajunk, Geisingen, Germany) in-plane under ultrasound control until needle tip hits the transverse process, a volume of 0.3 ml/kg of bupivacaine 0.25% (Marcaine, Astra Zeneca Pharmaceuticals) is injected. Pain management assessment and analgesic consumption will be provided through patient-controlled analgesia (PCA) for 24 hours. The PCA pump is programmed to deliver 1 mg morphine bolus per press with a lockout interval of 10 min. Pain scores will be measured using eleven points numerical rating scale NRS (0 to 10) and opioids consumption will be documented at 0, 1, 4, 8 and 24 hours. Time of admission to post-anesthesia care unit PACU is considered 0 hours. Any opioid equivalents given during the first 24 hours to manage breakthrough pain will be documented |
| Active Comparator: SAPB group Deep Serratus anterior plane block group | Procedure: SAPB group After giving general anesthesia, the patient is positioned in lateral decubitus, with the surgical side up. The upper arm is abducted and elevated above the head level. A block needle is introduced in-plane, targeting the plane deep to the serratus anterior muscle, and a bolus of 0.3 ml/kg bupivacaine 0.25% is injected through ultrasound guidance. Pain management assessment and analgesic consumption will be provided through patient-controlled analgesia PCA for 24 hours. The PCA pump is programmed to deliver 1 mg morphine bolus per press with a lockout interval of 10 min. Pain scores will be measured using eleven points numerical rating scale NRS (0 to 10), and opioids consumption will be documented at 0, 1, 4, 8 and 24 hours. Time of admission to PACU is considered 0 hours. Any opioid equivalents given during the first 24 hours to manage breakthrough pain will be documented |
Urvalskriterier
| Åldrar berättigade till studier | 18 Years Till 18 Years |
| Kön som är berättigade till studier | Female |
| Accepterar friska volontärer | Ja |
| Kriterier | Inclusion Criteria: - ASA I-III patients age 18 to 75 years undergoing unilateral breast surgery Exclusion Criteria: - Patients refusal - History of amide local anesthetics allergy - Alcohol or drug abuse - Chronic opioid intake - Language barriers - Patient with psychiatric disorders - Contraindications for regional anesthesia - BMI > 40 Kg/m2 - Obstructive sleep apnea that preclude PCA opioids |
Resultat
Primära resultatåtgärder
1. Cumulative Opioid consumption in the first 24 hours. [0 hours post- operative( 0 time is considered time to admission to post anesthesia care unit)]
2. Cumulative Opioid consumption in the first 24 hours. [1 hour post-operative]
3. Cumulative Opioid consumption in the first 24 hours. [4 hours post-operative]
4. Cumulative Opioid consumption in the first 24 hours. [8 hours post-operative]
5. Cumulative Opioid consumption in the first 24 hours. [24 hours post-operative]
6. Post-operative pain intensity [pain at 0 hour, 0 time is considered time to admission to post anesthesia care unit]
7. Post-operative pain intensity [pain at 1 hour post operative]
8. Post-operative pain intensity [pain at 4 hours post operative]
9. Post-operative pain intensity [pain at 8 hours post operative]
10. Post-operative pain intensity [pain at 24 hours post operative]
Sekundära resultatåtgärder
1. Time to patient mobilization [First 24 hours post operative( 0 time is considered time to admission to post anesthesia care unit)]
