- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03903224
Combined PECS II and Transversus Plane Blocks Versus Erector Spinae Block in Modified Radical Mastectomy
Effect of Combined Modified Pectoralis and Transversus Plane Blocks Versus Erector Spinae Block on Postoperative Analgesia Following Modified Radical Mastectomy
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Breast cancer is the most common malignancy in women in the United States and is second only to lung cancer as a cause of cancer death. Breast surgery is commonly performed as a part of the management of breast cancer, is associated with considerable acute postoperative pain. Ultrasound guided Regional anesthesia is recommended to be a part of multimodal analgesia in order to manage the acute post-operative pain. New techniques are proposed to give adequate control of postoperative analgesia with less opioid needs in the first day postoperative. They include pectoralis nerve modified pectoralis, and erector spinae blocks.
The investigators will compare Modified pectoralis nerve block (Pecs II) plus transversus thoracic muscle plane (TTP) block versus Erector spinae block on morphine consumption during first 24 h following modified radical mastectomy.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Abdelrahman H Mohammed, A Lecturer
- Phone Number: +2 01060989574
- Email: abdelrahmanhm89@gmail.com
Study Contact Backup
- Name: Mohamed H Bakri, Professor
- Phone Number: +2 01066356375
- Email: mhbakri@gmail.com
Study Locations
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Assiut, Egypt, 71515
- Assiut University Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age 18: 60 years old
- ASA (American Society of Anesthesiologists) physical status I II
- Female patients scheduled for modified radical mastectomy
Exclusion Criteria:
- Patient refusal or inability to give informed consent
- Subjects with a medical contraindication to regional anesthesia , such as coagulopathy, local infection or an allergy to local anesthetic
- Body mass index (BMI) >35
- Presence of psychiatric diseases
- History of chronic chest wall pain or neuropathic disorders
- Alcohol or drug abuse
- Severe chest wall deformities
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Active Comparator: Combined PECS II and TTP blocks (PT)
Modified Pectoralis block (PECS II) : Using ultrasound we proceed to inject 10 ml of bupivacaine 0.25% between the pectoral muscles and 10 ml under Pmm above the serratus muscle. Transversus Thoracic Plane block : 10 mL bupivacaine (0.25%) is injected between the transversus thoracic muscle and the internal intercostal muscle between the third and fourth left ribs connecting at the sternum. |
Modified pectoralis nerve block (Pecs II) aims to block at least the pectoral nerves, the intercostobrachial, intercostals III-IV-V-VI. This will cover dermatomes T2, T3 and T4. The probe is positioned under the lateral third of the clavicle .After locating the subclavian muscle, the axillary artery and the axillary vein we move the probe distally towards the axilla, until the pectoralis minor is identified. We start counting the ribs , from r1 under the axillary artery, we move distally and laterally until the lateral border of pectoralis minor is reached. The serratus anterior muscle which covers r2, r3, r4 is the point of entrance into the axilla. Blocking of multiple anterior branches of intercostal nerves (Th2-6) using a transversus thoracic muscle plane (TTP) block is used as an additive to pecs II to cover the internal mammary region
Other Names:
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Active Comparator: Erector Spinae Block (E)
Using ultrasound an echogenic 22-G block needle is inserted in-plane in a cranial-to-caudal direction until contact is made with the T5 transverse process.
A total of 30 bupivacaine 0.25% is then injected while seeing the fluid lifting the erector spinae muscle off.
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The patient is placed in a sitting position and The T5 spinous process is located by palpating and counting down from the C7 spinous process.
Under complete aseptic conditions a linear ultrasound probe is then placed in a transverse orientation at the level of the T5 transverse process.
The tip of the transverse process is centred on the ultrasound screen and the probe is then rotated into a longitudinal orientation to produce a parasagittal view.
From T1 to T5 the erector spinae, rhomboid major and trapezius muscles are visible posterior and superficial to the transverse processes.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The total morphine consumption postoperative (mg)
Time Frame: The first 24 hours postoperative.
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Morphine consumption in mg
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The first 24 hours postoperative.
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Postoperative pain score by Verbal numeric rating scale
Time Frame: 0, 2, 4, 8, 12, 24 hours postoperatively.
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Verbal numeric rating scale (VNRS) for postoperative pain monitoring using 11-point where zero equals no pain and 10 equals the worst pain imaginable.
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0, 2, 4, 8, 12, 24 hours postoperatively.
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Time to first request analgesia postoperative (min)
Time Frame: The first 24 hours postoperatively
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Time from postoperative period to time of first analgesic request in minutes
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The first 24 hours postoperatively
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Postoperative level of IL6 (interleukin 6) (pg/mL)
Time Frame: Two blood samples will be withdrawn from the patient. The first one is immediately preoperative and the second one after 24 hours postoperative
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Preoperative baseline and postoperative levels of IL6 will be measured (pg/mL)
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Two blood samples will be withdrawn from the patient. The first one is immediately preoperative and the second one after 24 hours postoperative
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Arterial blood gas: Arterial blood gas: Arterial blood gases
Time Frame: Before surgery and 24 hours postoperative.
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Oxygen (mmHg) and carbon dioxide (mmHg)
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Before surgery and 24 hours postoperative.
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Collaborators and Investigators
Sponsor
Investigators
- Study Director: Eman A Ismail, A Lectuer, Assiut University
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- Analgesia in breast surgey
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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