Effect of Combined Modified Pectoralis and Transversus Plane Blocks Versus Erector Spinae Block on Postoperative Analgesia Following Modified Radical Mastectomy
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 60
- 试验地点
- 2
- 主要终点
- The total morphine consumption postoperative (mg)
研究概览
简要总结
The aim of this study is to compare the total morphine consumption in the first 24 hour postoperative between combined modified pectoralis block (PECS II) and transversus plane block versus erector spinae block in modified radical mastectomy.
详细描述
Breast cancer is the most common malignancy in women in the United States and is second only to lung cancer as a cause of cancer death. Breast surgery is commonly performed as a part of the management of breast cancer, is associated with considerable acute postoperative pain. Ultrasound guided Regional anesthesia is recommended to be a part of multimodal analgesia in order to manage the acute post-operative pain. New techniques are proposed to give adequate control of postoperative analgesia with less opioid needs in the first day postoperative. They include pectoralis nerve modified pectoralis, and erector spinae blocks.
The investigators will compare Modified pectoralis nerve block (Pecs II) plus transversus thoracic muscle plane (TTP) block versus Erector spinae block on morphine consumption during first 24 h following modified radical mastectomy.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Single (Care Provider)
入排标准
- 年龄范围
- 18 Years 至 60 Years（Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •Age 18: 60 years old
- •ASA (American Society of Anesthesiologists) physical status I II
- •Female patients scheduled for modified radical mastectomy
排除标准
- •Patient refusal or inability to give informed consent
- •Subjects with a medical contraindication to regional anesthesia , such as coagulopathy, local infection or an allergy to local anesthetic
- •Body mass index (BMI) >35
- •Presence of psychiatric diseases
- •History of chronic chest wall pain or neuropathic disorders
- •Alcohol or drug abuse
- •Severe chest wall deformities
研究组 & 干预措施
Combined PECS II and TTP blocks (PT)
Modified Pectoralis block (PECS II) : Using ultrasound we proceed to inject 10 ml of bupivacaine 0.25% between the pectoral muscles and 10 ml under Pmm above the serratus muscle.
Transversus Thoracic Plane block : 10 mL bupivacaine (0.25%) is injected between the transversus thoracic muscle and the internal intercostal muscle between the third and fourth left ribs connecting at the sternum.
干预措施: Combined Modified Pectoralis and Transversus Plane Blocks (Procedure)
Erector Spinae Block (E)
Using ultrasound an echogenic 22-G block needle is inserted in-plane in a cranial-to-caudal direction until contact is made with the T5 transverse process. A total of 30 bupivacaine 0.25% is then injected while seeing the fluid lifting the erector spinae muscle off.
干预措施: Erector Spinae block (Procedure)
结局指标
主要结局
The total morphine consumption postoperative (mg)
时间窗: The first 24 hours postoperative.
Morphine consumption in mg
次要结局
- Postoperative level of IL6 (interleukin 6) (pg/mL)(Two blood samples will be withdrawn from the patient. The first one is immediately preoperative and the second one after 24 hours postoperative)
- Postoperative pain score by Verbal numeric rating scale(0, 2, 4, 8, 12, 24 hours postoperatively.)
- Time to first request analgesia postoperative (min)(The first 24 hours postoperatively)
- Arterial blood gas: Arterial blood gas: Arterial blood gases(Before surgery and 24 hours postoperative.)
研究者
Mohamed Bakri
Professor doctor of anaesthesia and ICU Faculty of Medicine - Assiut University
Assiut University