Study Results
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Basic Information
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COMPLETED
NA
70 participants
INTERVENTIONAL
2018-01-10
2018-11-30
Brief Summary
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Several techniques have been tried as.neuroaxial narcotics, intraperitoneal lavage of local anesthetic and transversus abdominis plan (TAP) block and successfully reduced opioid use and improve postoperative analgesia.
The ultrasound-guided erector spinae plan(ESP) block is a recently described technique which produces reliable unilateral analgesia at thoraco-lumbar dermatomes. ESP block carries the advantages of being simple, safe, easily recognizable by ultrasound, and a catheter can be threaded to extend the duration of analgesia.
Few case series reported the efficacy of (US)-guided ESP blocks in reducing postoperative pain and opioids consumption.
Because of that, the investigators aimed to test the hypothesis that US-guided ESP blocks can decrease opioid consumption during the first 24 h after of laparoscopic cholecystectomy in comparison with the conventional systemic analgesia.
Detailed Description
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Conditions
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Keywords
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Study Design
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RANDOMIZED
PARALLEL
PREVENTION
QUADRUPLE
Study Groups
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Group I (Control)
ultrasound guided Bilateral Erector Spinae Plan Block using isotonic saline
Erector Spinae Plan Block
The trocar site incision was done 15 minutes after the block in the three groups. The skin was disinfected with chlorhexidine solution, and the high-frequency transducer was isolated with a sterile disposable plastic cover and gel. The patient was placed in lateral position. A high-frequency linear ultrasound probe was placed longitudinally lateral to the T8 spinous process by 3 cm. After identification of the 3 muscles superficial to the hyperechoic transverse process shadow as follows: trapezius, rhomboid major, and erector spinae. The needle was introduced in a cephalo-caudal orientation. The needle tip was positioned fascial plane between rhomboid major and erector spinae muscles. Hydrodissection by 1-2 ml of normal saline to visualize the plan, then deposition of local anesthetic was done. A total of 20 mL of 0.25% bupivacaine was injected here. The same procedure was repeated on the other side.
Group II (ESP)
ultrasound guided Bilateral Erector Spinae Plan Block with bupivacaine 0.25%
Erector Spinae Plan Block
The trocar site incision was done 15 minutes after the block in the three groups. The skin was disinfected with chlorhexidine solution, and the high-frequency transducer was isolated with a sterile disposable plastic cover and gel. The patient was placed in lateral position. A high-frequency linear ultrasound probe was placed longitudinally lateral to the T8 spinous process by 3 cm. After identification of the 3 muscles superficial to the hyperechoic transverse process shadow as follows: trapezius, rhomboid major, and erector spinae. The needle was introduced in a cephalo-caudal orientation. The needle tip was positioned fascial plane between rhomboid major and erector spinae muscles. Hydrodissection by 1-2 ml of normal saline to visualize the plan, then deposition of local anesthetic was done. A total of 20 mL of 0.25% bupivacaine was injected here. The same procedure was repeated on the other side.
Group III(OSTAP)
Ultrasound-guided bilateral oblique subcostal TAP block
Oblique subcostal TAP
ultrasound-guided bilateral oblique subcostal TAP block with bupivacaine 0.25% (20ml on each side)
Interventions
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Erector Spinae Plan Block
The trocar site incision was done 15 minutes after the block in the three groups. The skin was disinfected with chlorhexidine solution, and the high-frequency transducer was isolated with a sterile disposable plastic cover and gel. The patient was placed in lateral position. A high-frequency linear ultrasound probe was placed longitudinally lateral to the T8 spinous process by 3 cm. After identification of the 3 muscles superficial to the hyperechoic transverse process shadow as follows: trapezius, rhomboid major, and erector spinae. The needle was introduced in a cephalo-caudal orientation. The needle tip was positioned fascial plane between rhomboid major and erector spinae muscles. Hydrodissection by 1-2 ml of normal saline to visualize the plan, then deposition of local anesthetic was done. A total of 20 mL of 0.25% bupivacaine was injected here. The same procedure was repeated on the other side.
Oblique subcostal TAP
ultrasound-guided bilateral oblique subcostal TAP block with bupivacaine 0.25% (20ml on each side)
Eligibility Criteria
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Inclusion Criteria
* 20-60 years old
* elective laparoscopic cholecystectomy
* Body mass index (BMI) less than 35
* Port sites at or above thoracic T 10 dermatome
Exclusion Criteria
* Presence of coagulopathy
* Local skin infection at the needle puncture sites
* Preoperative chronic dependence upon opioid and NSAID medications
* Liver or renal insufficiency
* History of psychiatric or neurological disease
* Deafness
* previous open surgery that need the conversion of laparoscopic to open surgery or manipulations more than expected with more tissue trauma
* American Society of Anesthesiologists (ASA) above Class II
20 Years
60 Years
ALL
Yes
Sponsors
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Al Jedaani Hospital
OTHER
Responsible Party
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Locations
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Al Jedaani group of hospitals
Jeddah, Meccah, Saudi Arabia
Countries
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References
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Ibrahim M. Erector Spinae Plane Block in Laparoscopic Cholecystectomy, Is There a Difference? A Randomized Controlled Trial. Anesth Essays Res. 2020 Jan-Mar;14(1):119-126. doi: 10.4103/aer.AER_144_19. Epub 2020 Feb 3.
Other Identifiers
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1/12
Identifier Type: -
Identifier Source: org_study_id