Ultrasound-Guided Erector Spinae Plane Block Versus Modified Thoracoabdominal Nerve Block for Perioperative Analgesia in Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy. A Randomized Comparative Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 40
- 试验地点
- 1
- 主要终点
- Time to first rescue analgesia
研究概览
简要总结
Obesity is a complex chronic disease that has become a major public health concern worldwide, with the prevalence of obesity increasing dramatically over the past few decades. Patients with morbid obesity pose a challenge for perioperative pain management. High ceiling analgesics-opioids have limited role due to safety concerns for patients with or without obstructive sleep apnea .
Insufficient postoperative pain management can have negative effects on recovery and quality of life, as well as limit patient comfort and delay the patient's ability to return to work after surgery .
Due to the numerous negative side effects of opioid drugs, including physical dependence, nausea, vomiting, and respiratory depression and subsequent airway obstruction, the Enhanced Recovery after Surgery (ERAS) guidelines for bariatric surgery currently advise opioid reduction in this procedure.
Ultrasound-guided erector spinae plane block (ESPB) and modified thoracoabdominal nerve block (M-TAPA) are both regional anesthesia techniques used to provide perioperative analgesia for obese patients undergoing LSG .
The ESPB targets the spinal nerves as they exit the erector spinae muscle, providing analgesia to the abdominal wall and paraspinal muscles. The technique has shown promising results in various surgical procedures and has a low risk of complications. By blocking the spinal nerves, the ESPB can provide effective pain relief in the postoperative period for patients undergoing LSG .
On the other hand, the M-TAPA targets the thoracic intercostal nerves and the abdominal wall, providing analgesia to these areas. The technique has been shown to provide effective perioperative analgesia in patients undergoing LSG. With or without ultrasound guidance, the use of M-TAPA can provide effective pain relief and reduce the need for opioid medication in the postoperative period.
This study aimed to compare the analgesic effect of ultrasound guided modified thoracoabdominal nerve block and an erector spinae plain block in patients undergoing LGS
详细描述
Patients will be randomly allocated into two groups: ESPB (n=20) and M TAPA (n=20).
- ESPB group: This group will receive ultrasound guided erector spinae plane block.
- M-TAPA group: This group will receive ultrasound guided modified thoracoabdominal nerve block.
Preoperative assessment:
The patient will enter the preparation room, he/she will be asked about his medical and surgical history in details and fasting hours (6-8 hrs) and full examination will be performed including airway examination. Lab investigations including complete blood count (CBC), coagulation profile, liver function tests and renal function tests will be checked.
The procedure will be explained to the patient and informed consent will be signed after his agreement then the patient will be classified into one of the groups.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •1. ASA II & ASA III.
- •Gender both males and females
- •Age group: from 18 to 65 years old
排除标准
- •• Patient refusal.
- •Uncooperative patients.
- •Allergy to local anesthetics.
- •Anatomical abnormality at injection site.
- •Redo or combined cholecystectomy surgery.
- •Infection at injection site.
研究组 & 干预措施
Erector Spinae Plane Block
Ultrasound-Guided Erector Spinae Plane Block
干预措施: nerve block (Procedure)
Modified Thoracoabdominal Nerve Block
Ultrasound-Guided Modified Thoracoabdominal Nerve Block
干预措施: nerve block (Procedure)
结局指标
主要结局
Time to first rescue analgesia
时间窗: the first 24 hours postoperatively
it is defined as time from extubation until time to first analgesic requirement during the first 24 hours postoperatively.
次要结局
- The total opioid consumption(the first 24 hours postoperatively)
研究者
Ahmed nabih youssef
lecturer of anesthesia
Kasr El Aini Hospital