Effect of Rectus Sheath Block on Diaphragmatic Function After Elective Upper Abdominal Surgery

Not Applicable

Recruiting

• Conditions: Acute Pain
• Interventions: Procedure: Rectus Sheath Block

• Registration Number: NCT03725527
• Lead Sponsor: Assiut University

Brief Summary

This study will be undertaken to investigate the respiratory and analgesic effects of ultrasound guided rectus sheath block analgesia after elective abdominal surgery with midline incision.

Detailed Description

A major proportion of pain experienced by patients undergoing abdominal surgeries is due to somatic pain signals derived from the abdominal wall. The central portion of anterior abdominal wall components (skin, muscles and parietal peritoneum) is innervated by sensory neurons branching from the anterior rami of spinal nerves T7 to T1. These neurons lie between the rectus abdominis muscle and posterior rectus sheath, and pierce the rectus muscle close to the midline. The tendinous intersections of the rectus muscle do not fuse with the posterior rectus sheath, thereby allowing the injectate to spread cephalo-caudally within this potential space. Rectus sheath (RS) block has been described for any midline abdominal incisions (epigastric and umbilical hernia repairs). As visceral pain becomes attenuated by the 2nd postoperative day, rectus sheath block can also be administered for midline laparotomy.

However, the effects of rectus sheath block analgesia on the respiratory function after abdominal surgery with midline incisions are still under investigation.

Study Timeline

• Study First Submitted: 2018-09-29
• Study First Submitted QC: 2018-10-29
• Study First Posted: 2018-10-31
• Study Start: 2020-05-01
• Status Verified: 2024-06
• Last Update Submitted: 2024-06-23
• Last Update Posted: 2024-06-25
• Primary Completion: 2026-01-01
• Study Completion: 2026-01-01

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 60

Inclusion Criteria

• Age: 18-50 years.
• Sex: both males and females.
• BMI< 30kg/m2.
• ASA physical status: 1, II and III.
• Elective abdominal surgery with midline incisions.

Exclusion Criteria

• Patient refusal.
• Infection at injection site
• Coagulation disorders.
• Allergy to study medications.
• Pregnancy.
• Respiratory tract infection within the last 2 weeks.
• Urgent abdominal surgery

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Rectus sheath block	Rectus Sheath Block	Patients will receive ultrasound-guided rectus sheath block' performed after induction of general anesthesia and before surgery.

Primary Outcome Measures

Name	Time	Method
Diaphragmatic inspiratory amplitude during quiet/deep breathing (DIA)/cm	24 hours Postoperative	The ultrasonic measurements of diaphragmatic motion will be attained at the posterior surface of the diaphragm. From the tracings on M-mode, the distance between echogenic lines (DIA) in centimeters and diaphragmatic inspiratory/expiratory velocity in centimeters/second during quiet, deep, and sniff breathing will be measured on the frozen images.

Secondary Outcome Measures

Name	Time	Method
Verbal Rating Scale	24 hours Postoperatively	Verbal rating pain scale (VRS) (Ranging from 0 to 4), where 0=no pain, 1=mild pain, 2=moderate pain, 3=severe pain and lastly 4 =excruciating pain) will be recorded at rest and upon patient coughing; on admission to PACU (baseline), and 2, 4, 6, 12, and 24h postoperatively.
Forced Vital Capacity/L	24 hours Postoperatively	Measurements of Forced vital capacity (FVC) will be measured by the use of hand-held spirometer (One-flow®, Clement Clarke, U.K). At each assessment, the largest values of FVC will be recorded.

Trial Locations

Locations (1)

Assiut university main hospital, ICUs; 🇪🇬 Assiut, Assiut Governorate, Egypt