Comparison Of Erector Spinae Plane Block With Transversus Abdominis Plane Block For Postoperative Pain Management In Patients Undergoing Total Abdominal Hysterectomy

Summary

Hysterectomy is the second most common major Obstetric/gynecology procedure worldwide and one of the most common procedures in our institute. Post-operative pain is one of the most common complications following hysterectomy. Patients report moderate to severe pain following hysterectomy. Transversus abdominis plane block(TAP) is an established technique for abdominal and pelvic analgesia. Although efficient as an analgesic technique, it lacks visceral analgesia.Erector spinae plane block (ESP) is one of the newer developed regional techniques. Initially developed for Thoracic Neuropathic Pain by Forero et al, its use has expanded to include thoracic, abdominal and even femoral and below knee operative pain management.

Objective:

The objective of this study is to compare the ESP block with the TAP block for postoperative pain management in cases undergoing Total abdominal hysterectomy.

Methods:

A hospital based randomized, prospective, interventional study will be performed on all consenting patients undergoing total abdominal hysterectomy under general anesthesia. The required number of participants will be selected by probability sampling.

Fourty four female participants posted for elective Total abdominal hysterectomy under general anesthesia will be randomized onto two groups. The process of randomisation will be via computer generated randomization sequence.Each of the group will receive either of the two intervention after the completion of operative procedure. The post operative anelgesia duration and NRS score will be compared between the two groups.

Approval will be taken from the Institutional Review Committee (IRC) of Institute of Medicine.

Written consent will be taken prior to the data collection. Data will be entered in Microsoft Excel and errors will be checked. The clean data will be transferred into SPSS v 20 for analysis The results will be presented in terms of frequency percentage and table The associations will be established.

Conditions

• Pain, Postoperative

Interventions

PROCEDURE

Erector Spinae Plane Block(Bilateral Ultrasound Guided Erector Spinae Plane Block)

Bilateral USG guided Erector Spinae Plane Block: Drug used 20 ml of 0.25% Bupivacaine in each side. Total 40 ml volume. Dosage 100mg Ultrasound transducer will be placed in a cephalocaudal orientation over the back at 10th thoracic vertebral level. The probe will then slowly be moved laterally until the transverse process is visible The trapezius muscle and erector spinae muscle will be identified as superficial to the transverse process. A 25-gauge Quincke spinal needle (Romsons spinal needle, Quincke type)will be inserted using an in-plane approach in the cephalad to the caudal direction and towards the transverse process. A 5ml bolus of local anesthetic will be given. Erector spinae muscle plane is then visualized separating from the transverse process. The local anesthetic is then injected in 5 ml increments, with aspiration after every 5 ml to avoid intravascular injection Same procedure will be repeated on the other side

PROCEDURE

Transversus abdominis plane block(Bilateral Ultrasound-guided bilateral Transversus abdominis plane block)

Bilateral Ultrasound-guided bilateral Transversus abdominis plane block Drug used 20 ml of 0.25% Bupivacaine in each side. Total 40 ml volume. Dosage 100mg The linear transducer will be placed in the transverse plane at the lateral abdominal wall in the mid-axillary line, between the lower costal margin and the iliac crest. Abdominal wall muscles (external oblique, internal oblique, and transversus abdominis) will be visualized. Bowel movement and visualization of hypoechoic peritoneum would further guide the block. The needle will be inserted in-plane and advanced until the tip is between the internal oblique and the transversus abdominis muscle. After negative aspiration, 20 mL of 0.25% bupivacaine is injected in a 5ml increment ,aspirating after every 5ml injection. Same procedure will be repeated on the other side.

Sponsors & Collaborators

• Tribhuvan University Teaching Hospital, Institute Of Medicine.

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

TRIPLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

FEMALE

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2022-11-10

Primary Completion

2023-04-10

Completion

2023-08-10