Adding Magnesium Sulfate or Dexmedetomidine to Bupivacaine in Oblique Subcostal Tap Block for Laparoscopic Cholecystectomy: a Randomized Double -Blind Controlled Study

NCT ID: NCT06743919

Last Updated: 2024-12-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

PHASE4

Total Enrollment

63 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-01-01

Study Completion Date

2026-03-01

Brief Summary

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Laparoscopic cholecystectomy (LC) is one of the commonly performed surgical procedures associated with a moderate degree of postoperative pain especially on the 1st postoperative day. Adequate postoperative analgesia allows early patient ambulation, decreases analgesic requirements, and hospital stay. Moreover, it has been hypothesized that intense acute pain after LC may predict development of chronic pain (e.g., post laparoscopic cholecystectomy syndrome). So, aggressive perioperative analgesia is needed.

the aim of the study is To compare the analgesic effect of magnesium sulfate combined with bupivacaine versus bupivacaine combined dexmedetomidine via OSCTAB block on postoperative pain control for 24 hours in patients scheduled for LC.

Detailed Description

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Transversus abdominis plane (TAP) block is a recent analgesic technique with efficacy in perioperative pain therapy for LC. It involves the infusion of local anesthetic into the fascial plane of the abdominal wall.

Oblique subcostal transversus abdominis plane (OSCTAP) block is an US-guided regional anesthesia technique that anesthetizes the nerves of the lower and upper anterior abdominal wall, specifically from T6 to L1. There weren't enough studies in the literature evaluating the OSCTAP block for pain management after LC.

Rafi et al and McDonnell et al were first to describe this novel abdominal field block. They described an anatomical landmark technique and provided evidence of blockade to the mid/lower thoracic and upper lumbar spinal nerves as they travelled in the fascial plane between the transversus abdominis (TA) and internal oblique (IO) muscles.

The OSCTAB block provides more effective analgesia than other TAP blocks. Numerous regional anesthetic adjuvants.

such as dexmedetomidine, clonidine, epinephrine, dexamethasone, and magnesium sulphate (MgSO4) are usually combined with enhancement of analgesic efficacy.

Recently, these adjuvants added to LA solution for prolonging the effect of TAP block with promising results.

Conditions

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Laparoscopic Cholecystectomy

Keywords

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Oblique Subcostal Tap Block

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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group 1

patient will receive 20 ml bupivacaine 0.25% plus 500 mg magnesium sulfate in 5ml normal saline on both sides.

Group Type EXPERIMENTAL

Magnesium sulfate 50% - 1g/h

Intervention Type DRUG

magnesium sulfate group 20 ml bupivacaine 0.25% plus 500 mg magnesium sulfate in 5ml normal saline on both sides.

Bupivacaine

Intervention Type DRUG

20 ml bupivacaine 0.25% plus 5 ml normal saline on both sides.

group 2

patients will receive 20 ml bupivacaine 0.25% plus o .5 microg per kg dexmedetomidine in 5 ml normal saline on both sides.

Group Type EXPERIMENTAL

dexmedetomidine 0.5 µg/kg IV

Intervention Type DRUG

dexmedetomidine group 20 ml bupivacaine 0.25% plus o .5 microg per kg dexmedetomidine in 5 ml normal saline on both sides.

Bupivacaine

Intervention Type DRUG

20 ml bupivacaine 0.25% plus 5 ml normal saline on both sides.

group 3

patients will receive 20 ml bupivacaine 0.25% plus 5 ml normal saline on both sides.

Group Type PLACEBO_COMPARATOR

Bupivacaine

Intervention Type DRUG

20 ml bupivacaine 0.25% plus 5 ml normal saline on both sides.

Interventions

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Magnesium sulfate 50% - 1g/h

magnesium sulfate group 20 ml bupivacaine 0.25% plus 500 mg magnesium sulfate in 5ml normal saline on both sides.

Intervention Type DRUG

dexmedetomidine 0.5 µg/kg IV

dexmedetomidine group 20 ml bupivacaine 0.25% plus o .5 microg per kg dexmedetomidine in 5 ml normal saline on both sides.

Intervention Type DRUG

Bupivacaine

20 ml bupivacaine 0.25% plus 5 ml normal saline on both sides.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* • Patients programmed for elective LC.

* American society of anesthesiologists (ASA) physical state I or II.
* Age over 18 years and less than 60 years old.
* Patients of both sex are included in the study.

Exclusion Criteria

* •Patient refusal

* Known hypersensitivity to the study drugs.
* Body Mass Index \> 40 kg/m2.
* Inability to accurately describe postoperative pain to investigators.
* Opioid tolerance or dependence.
* Preexisting history of chronic pain.
* History of renal, liver, cardiac, neuropsychiatric disorder problems.
* Bleeding or coagulation abnormality.
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Assiut University

OTHER

Sponsor Role lead

Responsible Party

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Khaled Zaki Mousa Sayed Mansour

resident doctor at Assiut University hospital

Responsibility Role PRINCIPAL_INVESTIGATOR

Central Contacts

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Khaled Zaki Mousa Sayed Mansour, resident doctor

Role: CONTACT

Phone: +2 01032468020

Email: [email protected]

References

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Sun C, He Z, Feng B, Huang Y, Liu D, Sun Z. Effect of Intraperitoneal Instillation of Dexmedetomidine With Local Anesthetics in Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis of Randomized Trials. Surg Laparosc Endosc Percutan Tech. 2024 Apr 1;34(2):222-232. doi: 10.1097/SLE.0000000000001262.

Reference Type BACKGROUND
PMID: 38359350 (View on PubMed)

Lee TH, Barrington MJ, Tran TM, Wong D, Hebbard PD. Comparison of extent of sensory block following posterior and subcostal approaches to ultrasound-guided transversus abdominis plane block. Anaesth Intensive Care. 2010 May;38(3):452-60. doi: 10.1177/0310057X1003800307.

Reference Type BACKGROUND
PMID: 20514952 (View on PubMed)

O'Donnell BD, McDonnell JG, McShane AJ. The transversus abdominis plane (TAP) block in open retropubic prostatectomy. Reg Anesth Pain Med. 2006 Jan-Feb;31(1):91. doi: 10.1016/j.rapm.2005.10.006. No abstract available.

Reference Type BACKGROUND
PMID: 16418039 (View on PubMed)

Hebbard PD, Barrington MJ, Vasey C. Ultrasound-guided continuous oblique subcostal transversus abdominis plane blockade: description of anatomy and clinical technique. Reg Anesth Pain Med. 2010 Sep-Oct;35(5):436-41. doi: 10.1097/aap.0b013e3181e66702.

Reference Type BACKGROUND
PMID: 20830871 (View on PubMed)

Hutchins J, Delaney D, Vogel RI, Ghebre RG, Downs LS Jr, Carson L, Mullany S, Teoh D, Geller MA. Ultrasound guided subcostal transversus abdominis plane (TAP) infiltration with liposomal bupivacaine for patients undergoing robotic assisted hysterectomy: A prospective randomized controlled study. Gynecol Oncol. 2015 Sep;138(3):609-13. doi: 10.1016/j.ygyno.2015.06.008. Epub 2015 Jun 6.

Reference Type BACKGROUND
PMID: 26056753 (View on PubMed)

Rozen WM, Tran TM, Ashton MW, Barrington MJ, Ivanusic JJ, Taylor GI. Refining the course of the thoracolumbar nerves: a new understanding of the innervation of the anterior abdominal wall. Clin Anat. 2008 May;21(4):325-33. doi: 10.1002/ca.20621.

Reference Type BACKGROUND
PMID: 18428988 (View on PubMed)

Bisgaard T, Rosenberg J, Kehlet H. From acute to chronic pain after laparoscopic cholecystectomy: a prospective follow-up analysis. Scand J Gastroenterol. 2005 Nov;40(11):1358-64. doi: 10.1080/00365520510023675.

Reference Type BACKGROUND
PMID: 16334446 (View on PubMed)

Petersen PL, Stjernholm P, Kristiansen VB, Torup H, Hansen EG, Mitchell AU, Moeller A, Rosenberg J, Dahl JB, Mathiesen O. The beneficial effect of transversus abdominis plane block after laparoscopic cholecystectomy in day-case surgery: a randomized clinical trial. Anesth Analg. 2012 Sep;115(3):527-33. doi: 10.1213/ANE.0b013e318261f16e. Epub 2012 Jul 4.

Reference Type BACKGROUND
PMID: 22763903 (View on PubMed)

Other Identifiers

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OSCTAP Cholecystectomy

Identifier Type: -

Identifier Source: org_study_id