Transversus Abdominis Plane Block Versus Erector Spinae Plane Block

Not Applicable

Completed

• Conditions: Postoperative Pain; Laparotomy
• Interventions: Other: control group; Procedure: transversus abdominis plane block; Procedure: erector spinae plane block

• Registration Number: NCT03989570
• Lead Sponsor: Hassan Mokhtar Elshorbagy Hetta

Brief Summary

The TAP block, first described by Rafi in 2001, is comprised of deposition of a local anesthetic into the anatomical plane between the internal oblique and transverses abdominis muscles, where thess thoracoabdominal nerves (T6-L1) contribute to the main sensory supply of the skin, muscles, and parietal peritoneum of the anterior abdominal wall. These nerves branch and communicate extensively with each other in the TAP .

Erector spinae plane (ESP) block is a recently described interfascial block in which the local anaesthectic is placed over or below the plane of the erector spinae muscle, near where the spinal nerves come out from the spine before they start to divide. Some publications have shown its effectiveness in treating thoracic and abdominal postoperative pain.

Postoperative pain is the major obstacle for early postoperative ambulation and increases the risk of venous thromboembolism, respiratory complications and prolongs the hospital stay. Parietal pain is the chief component of postoperative pain after abdominal surgeries. Large doses of opioids are required to mitigate this pain, but they are poorly tolerated. Multimodal analgesia is effective in handling postoperative pain and in attenuating the side effects of large doses of a single analgesic .

Detailed Description

Group I (A group): Will undergo ESP block with 40 ml bupivacine 0.25% (20 ml on each side), and TAP block with 40 ml saline 0.9% (20 ml on each side).

Group II (B group): Will undergo TAP block with 40 ml bupivacine 0.25% (20 ml on each side), and ESP block with 40 ml saline 0.9% (20 ml on each side).

Group III (C group): anesthetized with the protocol followed by Minia University Hospital The medication will be prepared and supplied in similar syringes by an anesthetist not included in the management of the patint or data collection.

Methods:

Following placement of the standard monitors, intravenous access will secured and the patients will started on IV fluids. Anesthesia will be induced with 0.04 mg/kg midazolam, 2 μg/kg fentanyl, and titrated doses of propofol. Endotracheal intubation will facilitated with 0.5 mg/kg of atracurium. Isoflurane 1.2%, will be used for anesthetic maintenance After induction of anesthesia, stabilizing the patient's hemodynamics, and before surgical incision, ESB \& TAP block will be performed. With the patient in the supine position, the site of the ultrasound and needle entry will be sterilized. The TAP block will be performed laterally behind the midaxillary line between the iliac crest and the most inferior extent of the ribs. The plane between the internal oblique and transversus abdominis muscle will be located around the midaxillary line with the probe transverse to the abdomen. Anteriorly,The needle will be passed to come in plane with the ultrasound beam and placed between transversus and internal oblique posterior to the midaxillary line then, the local anesthetic will be injected. Then the patient will turn in lateral position, the site of the ultrasound and needle entry will be sterilized. The ESP block will be performed into a fascial plane between the deep surface of erector spinae muscle and the transverse processes

Study Timeline

• Study First Submitted: 2019-05-04
• Study Start: 2019-05-15
• Study First Submitted QC: 2019-06-17
• Study First Posted: 2019-06-18
• Primary Completion: 2020-02-01
• Results First Submitted: 2020-02-11
• Study Completion: 2020-02-12
• Results First Submitted QC: 2020-03-24
• Results First Posted: 2020-03-25
• Status Verified: 2020-06
• Last Update Submitted: 2020-06-18
• Last Update Posted: 2020-06-30

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 100

Inclusion Criteria

• 1. Age18-70 . 2. Both gender . 3 .Emergency laparotomies . 4. ASA I-III .

Exclusion Criteria

1. Drug allergy .
2. Morbid obesity (BMI >40 kg/m2) .
3. Psychiatric disorder .
4. Opioid dependence .
5. patient refuse

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Group III (C group)	control group	31 patients anesthetized with the protocol followed by Minia University Hospital
Group II (B group)	transversus abdominis plane block	31patients Will undergo TAP block with 40 ml bupivacine 0.25% (20 ml on each side), and ESP block with 40 ml saline 0.9% (20 ml on each side).
Group I (A group)	erector spinae plane block	31 patients Will undergo ESP block with 40 ml bupivacine 0.25% (20 ml on each side), and TAP block with 40 ml saline 0.9% (20 ml on each side).

Primary Outcome Measures

Name	Time	Method
Postoperative Total Fentanyl Requirement	24 hours	The total amount of postoperative fentanyl in milligram was given to the patient as rescue analgesia during 24 hours
Time of First Post Operative Analgesic Request	24 hours	the pain will be assisted based on the time for the first dose of rescue analgesia

Secondary Outcome Measures

Name	Time	Method
Incidence of Any Adverse Events	5 days	adverse events related to technique or drugs

Trial Locations

Locations (1)

Minia University Hospital; 🇪🇬 Minya, Egypt