To compare epidural analgesia and recuts sheath analgesia for pain management in abdominal surgery.

Not yet recruiting

• Conditions: Disease of digestive system, unspecified, (2) ICD-10 Condition: K639||Disease of intestine, unspecified,

• Registration Number: CTRI/2023/09/057698
• Lead Sponsor: Dr Mukesh Kumar

Brief Summary

Neuroendocrine stress caused due to surgery, resulting in undesirable hemodynamic instability, alterations in metabolic response and malfunctioning of the immune system. Pain is a common cause of stress, therefore it should be adequately evaluated and treated both during surgery and afterwards. Pain is a very complex, subjective perceptual phenomenon. It’s dimensions like intensity, quality, duration and impacts varies from patient to patient.

 Abdominal incision surgeries are still necessary for a number of emergency and elective treatments, despite the rise of less invasive abdominal surgical techniques.

Regional anaesthesia has become an integral and common component of both intraoperative anaesthesia and postoperative analgesia.

 For abdominal, major vascular, and cardiothoracic surgery, thoracic epidural anaesthesia is increasingly employed, followed by post-operative epidural analgesia.Pain management and severe sympatholysis can contribute to improved postoperative outcomes like increased respiratory function, decreased ileus, and protein sparing by allowing patients to cough, breathe deeply, drink, and move around.

 To successfully do an epidural block, one must have a thorough understanding of the differences between thoracic and lumbar anatomy.Local anaesthetics have different dermatomal sensory distribution depending on where they are injected. Despite having a noticeable caudal spread, high-thoracic epidurals have little cranial spread. In contrast, more cranial distribution happens after low-than-high or mid-thoracic epidurals.

 Higher concentrations of bupivacaine (0.5%) or its equivalent are preferred, as onset of sensory block is rapid and muscle relaxation is profound, thus reducing the need for intraoperative neuromuscular blocking agents and same can be repeated intraoperative and post operative periods.

Abdominal trunk local anaesthetic (LA) blocks are one of the multimodal opioid-sparing strategies being used in the therapy of post-laparotomy pain.Effective post-laparotomy analgesia can be achieved while avoiding some of the negative effects associated with opioid and thoracic epidural procedures by using abdominal trunk blocks, such as rectus sheath (RS) and transversus abdominis plane (TAP) blocks.

The paired rectus abdominis muscles and their anterior and posterior sheaths are the key anatomical landmarks of RSCA.Innervation of the anterior abdominal wall arises from the ventral rami of the thoracic nerves (T6-T11), the subcostal nerve (T12), and first lumbar nerve (iliohypogastric and ilioinguinal nerves). The main application of RSCA is for patients undergoing surgery by giving a midline or para-median abdominal incision.

 RSCs can be placed before abdominal incision, during surgery with the abdomen open, or after surgery once the abdomen has been closed. RSC insertion must be performed under aseptic conditions. With the patient positioned supine. Manual bolus regimens of 20 ml bupivacaine 0.25% Is given via catheters.

 We plan a prospective, randomised study to compare post operative analgesic efficacy of Epidural Analgesia and Rectus Sheath Catheter Analgesia in abdominal surgeries under general anaesthesia by taking count on post operative pain score (VAS Score) and analgesic requirements of patients.

Detailed Description

Not available

Study Timeline

• Last Update Posted: 2023-09-13
• Study Start: 2023-09-25

Recruitment & Eligibility

• Status: Not Yet Recruiting
• Sex: All
• Target Recruitment: 60

Inclusion Criteria

Patients with ASA 1 and 2 Patients undergoing abdominal surgeries under GA.

Exclusion Criteria

Patients with allergy to drug Patients with coagulation disorders Patient with spine deformities Patients with abnormalities of spine Any sign of local infection.

Study & Design

• Study Type: Interventional
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
To study study postoperative analgesia in patients with epidural analgesia	Till72 hours postoperative
To study postoperative analgesia in patients with recuts sheath analgesia	Till72 hours postoperative

Secondary Outcome Measures

Name	Time	Method
To compare postoperative analgesia in patients with epidural analgesia and and recuts sheath analgesia	Till 72 hours postoperative

Trial Locations

Locations (1)

,Guru Gobind Singh medical college and Hospital; 🇮🇳 Faridkot, PUNJAB, India

,Guru Gobind Singh medical college and Hospital

🇮🇳Faridkot, PUNJAB, India

Sumit Kumar

Principal investigator

9518437940

drsumitkaushik18414@gmail.com