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Management of Acute Appendicitis Pain in the Emergency Department

NCT06808087 · Status: COMPLETED · Type: OBSERVATIONAL · Enrollment: 96

Last updated 2026-02-20

No results posted yet for this study

Summary

This study aims to compare the effectiveness of TAP (Transversus Abdominal Plane) block, ESPB (Erector Spinal Plane Block), and tramadol in preoperative pain management for patients diagnosed with acute appendicitis and undergoing emergency surgery in the emergency department. The study will evaluate the potential of TAP block and ESPB administered to patients diagnosed with acute appendicitis in the emergency department to reduce pain intensity before surgical intervention. This study aims to contribute to practical applications to ensure optimal pain control for acute appendicitis patients under emergency department conditions.

Conditions

  • Acute Appendicitis

Interventions

PROCEDURE

Transversus abdominis plane blockage

1. Patient monitoring 2. Preparation of the skin with 10% povidone-iodine and ensuring appropriate draping 3. Placement of a high-frequency linear transducer transversely between the right iliac crest and subcostal margin along the midaxillary line. Structures visualized on ultrasound from superficial to deep include: skin, subcutaneous fat, external oblique muscle, internal oblique muscle, transversus abdominis muscle, and peritoneum. The TAP block will be performed in the transversus abdominis plane (TAP) between the internal oblique and transversus abdominis muscles. 4. A 23-gauge, 60 mm blunt-tipped needle will be directed toward the TAP, and negative aspiration will be confirmed upon entry into the fascial layer. 5. An injection of 20 mL of 0.25% bupivacaine, prepared by diluting 10 mL of 0.5% bupivacaine with 10 mL of normal saline, will be performed. 6. Visualization of the oval spread of bupivacaine in the TAP.

PROCEDURE

Erector spinae plane blockage

1. Patient monitoring 2. Positioning the patient in the prone position 3. Preparation of the skin with 10% povidone-iodine and ensuring appropriate draping 4. Counting the transverse processes from the sacrum to find the L1 level 5. Placing a low-frequency curvilinear transducer (depth set to 3-5 cm) parasagittally, and identifying the tip of the right transverse process at this level 6. Visualizing the erector spinae muscle overlying the transverse process 7. Inserting a 22G, 80 mm needle between the transverse process and the fascia of the erector spinae muscle 8. Injecting 1 to 3 mL of saline to confirm the separation of the erector spinae muscle fascia from the transverse process after negative aspiration 9. Injecting 20 mL of 0.25% bupivacaine, prepared by diluting 10 mL of 0.5% bupivacaine with 10 mL of normal saline, after another negative aspiration 10. Visualizing the oval spread of bupivacaine over the erector spinae muscle.

DRUG

Tramadol

50 mg of tramadol will be administered via IV infusion over 15 minutes in 100 cc of isotonic 0.9% NaCl (normal saline).

Sponsors & Collaborators

  • Ankara City Hospital Bilkent

    lead OTHER

Principal Investigators

  • Ahmet Burak Erdem · Ankara Etlik City Hospital

Eligibility

Min Age
18 Years
Sex
ALL
Healthy Volunteers
No

Timeline & Regulatory

Start
2024-05-08
Primary Completion
2024-12-15
Completion
2024-12-15

Countries

  • Turkey (Türkiye)

Study Locations

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Read the full study record

This page highlights key information. For complete eligibility criteria, study locations, investigator contacts, and the full protocol, visit the original record on ClinicalTrials.gov.

View NCT06808087 on ClinicalTrials.gov