COMPARISON OF ULTRASOUND GUIDED RECTUS SHEATH BLOCK AND OBLIQUE SUBCOSTAL TRANSVERSUS ABDOMINIS PLANE BLOCK FOR PERIOPERATIVE ANALGESIA FOR MIDLINE INCISION ABDOMINAL SURGERIES

Not yet recruiting

• Conditions: Malignant neoplasm of rectosigmoidjunction, (2) ICD-10 Condition: C179||Malignant neoplasm of small intestine, unspecified, (3) ICD-10 Condition: C569||Malignant neoplasm of unspecifiedovary,

• Registration Number: CTRI/2021/07/034703

Brief Summary

·      Patients undergoing abdominal surgical procedures with midline incision experience significant pain.

·      Postoperative pain therapy is a key element of efficient postoperative care. Inadequate pain control may delay the recovery of patients, prolong hospital stay, increased expenses and may precipitate chronic pain.

·      Historically, pain control is accomplished through opioid administration, which is associated with side effects such as sedation, respiratory depression, pruritus, hallucinations, postoperative nausea and vomiting (PONV). Administration of multimodal analgesics could limit the excessive use of systemic opioid analgesia.

·      Epidural analgesia remains the gold standard for pain control for abdominal surgical procedures. .However,  epidural  analgesia  complications include  hypotension,  bradycardia,  dural  puncture, spinal  infection, immobilization due to motor block, urine retention and rarely neurological damage.

·      Due to these risks, alternative approaches to traditional anesthetic techniques should also be assessed.The idea of oblique subcostal transversus abdominis plane block (OSTAPB) and rectus sheath block is to anesthetize part of or the entire abdominal wall instead of using intrathecal or epidural techniques.

·      These blocks may also be effective in reducing postoperative pain in midline incisional abdominal surgery as an alternative method of epidural analgesia in anticoagulated patients.

·      The rectus sheath block was first described by Schleich in 1899 as a means of facilitating surgery involving the anterior abdominal wall in adults.It was initially used for abdominal wall muscle relaxation and analgesia during midline laparotomy by blocking the terminal branches of the9th, 10th and 11th intercostal nerves located in the space between the rectus abdominis muscle and its posterior rectus sheath. It has been used for postoperative analgesia extending along the midline for upper abdominal surgeries, abdominal gynecological procedures, and abdominoplasty.

·      The oblique subcostal transversus abdominis plane block (OSTAPB) is a regional anesthetic technique that targets the injection of the local anesthetic (LA) in the neurovascular plane between the rectus abdoiminis muscle and transversus abdominis muscle.Hebbard*et al*. (2010) described the US-guided continuous oblique subcostal TAP block. With a single oblique subcostal TAP block (OSTAPB) injection, the sensory block extends to the thoracolumbar nerves (T6-L1) making the block beneficial for midline abdominal incisions also.

Detailed Description

Not available

Study Timeline

• Last Update Posted: 2021-06-07
• Study Start: 2021-07-19

Recruitment & Eligibility

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

Inclusion Criteria

• Patient fulfilling criteria of American Society of Anaesthesiology (ASA) of Classes I/II.
• Patient aged 18-65 years.
• Patients undergoing Midline incision abdominal surgeries under general anaesthesia.
• Patient’s giving consent willingly.

Exclusion Criteria

• Patient with ASA CLASSIII,IV & V.
• Patient refusal.
• Allergy to study medications Infection at the site of proposed block.
• Anatomic abnormalities.
• Inability to comprehend or participate in pain scoring system.

Study & Design

• Study Type: Interventional
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
•To assess the analgesic efficacy of rectus sheath block.	24 hrs
•To assess the analgesic efficacy of oblique subcostal TAP block.	24 hrs
•To compare the analgesic efficacy of both blocks.	24 hrs

Secondary Outcome Measures

Name	Time	Method
To note and compare requirement of supplementalanalgesic during   surgery in both thegroupsTocompare intraoperative hemodynamic parameters heart rate  systolic bloodpressure diastolic blood pressure mean arterial pressure in both groupsToassess and compare postoperative visual analogue scale  score  at rest and with movement Time torequest for first rescue analgesia in both the groups Totaldose of tramadol required in 24 hrsÂ	24 hrs

Trial Locations

Locations (1)

Mahatma Gandhi Medical College & Hospital; 🇮🇳 Jaipur, RAJASTHAN, India

Mahatma Gandhi Medical College & Hospital

🇮🇳Jaipur, RAJASTHAN, India

Dr Saravjot Kaur Sandhu

Principal investigator

8847662441

sandhusabinaz@gmail.com