Modified thoracoabdominal nerve block with guidance of ultrasound by perichondrial approach for perioperative analgesia in paediatric patients posted for nephrectomy- A case series
- Conditions
- Other specified disorders of kidney and ureter,
- Registration Number
- CTRI/2024/01/061958
- Lead Sponsor
- VIKASH KUMAR
- Brief Summary
This study will be conducted afterinstitutional ethical committee approval and Clinical Trials Registry India(CTRI) registration. Written informed consent of patient will be taken.
Standard monitoringwith electrocardiography, non-invasive blood pressure, capnography, a multi-gasanalyser, and peripheral oxygen saturation will be performed on all patients inthe operating room. Mechanical ventilation will be achieved using apressure-controlled mode to maintain end-tidal carbon dioxide at 35 to40 mm Hg. Depth of anaesthesia will be controlled during surgery usingend-tidal sevoflurane and maintaining the sevoflurane concentration (0.8-1MAC).M-TAPA will be administered bilaterally by a single anaesthesiologist after theinduction of general anaesthesia before the surgical procedure.
Anaesthesia induction and endotracheal intubation willbe performed intravenously usingpropofol 2 mg/kg, fentanyl 1-2 µg/kg, and atracurium 0.5 mg/kg.Anaesthesia will be maintained with sevoflurane and oxygen and nitrous oxide.
M-TAPA technique- M-TAPA will be performed bilaterally by asingle anaesthesiologist, as described by Tulgar et al. Following the trachealintubation and before the surgical procedure, transversus abdominis, internaloblique, and external oblique muscles were identified with a high-frequency(12 MHz) linear probe on the costochondral angle in the sagittal planeunder ultrasound guidance at the 10th costal margin. A deep angle will be givento the costochondral angle at the edge of the 10th costa with the probe in thesagittal direction to view the lower surface of the costal cartilage in themidline. A 21-G, 80-mm block needle was inserted in the cranial direction usingthe in-plane technique and the needle tip will be moved to the posterior aspectof the 10th costal cartilage. It will be noted that the needle tip nevercrossed the cranial edge of the 10th costal cartilage and 25 mL of 0.25%bupivacaine will be injected into the lower surface of the chondrium. The sameprocess will be repeated for the other side.
The primary objective of the study will be to evaluate theneed for first rescue analgesia in the first postoperative 24 h inpatients with and without M-TAPA block. Pain severity will be measured using CHEOPSscale and FLACCS scale. Both will be recorded postoperatively at 0 and 2, 6, 12hrs. If FLACC score above 4 rescue analgesic will be given.
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- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Not Yet Recruiting
- Sex
- All
- Target Recruitment
- 30
•Patients of ASA physical status 1,2 •Patients between 2-15 years of age of either sex posted for nephrectomy •Patient attendant able to comprehend and willing to participate •Patients scheduled for general elective surgeries.
•Patients attendant who refuse to participate •Patients allergic to bupivacaine •Patients having infection at drug administration site •Patients having coagulopathy.
Study & Design
- Study Type
- Interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method The primary objective of the study will be to evaluate the need for first rescue analgesia in the first postoperative 24 h in patients The primary objective of the study will be to evaluate the need for first rescue analgesia in the first postoperative 24 h in patients
- Secondary Outcome Measures
Name Time Method To measure hemodynamics of the patient Upto 24 hour postoperatively
Trial Locations
- Locations (1)
Paediatrics Surgery OT
🇮🇳Patna, BIHAR, India
Paediatrics Surgery OT🇮🇳Patna, BIHAR, IndiaVikash KumarPrincipal investigator8409697069vkskmc@gmail.com