- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05452369
Postoperative Anelgesic Effect of Rhomboid Intercostal Nerve Block Versus Erector Spinae Plane Block
Ultrasound Guided Rhomboid Intercostal Nerve Block Versus Erector Spinae Plane Block for Postoperative Analgesia in Modified Radical Mastectomy:A Comparative Study
Despite of analgesic effect of intravenous analgesic medications at intraoperative and postoperative time , The regional anesthetic techniquehas more benefits suchbetter control of Acute pain and hence less chronic pain and decreases the need for opioids and analgesics to preserve immune function which responsible for higher rates of infection and local recurrence, even metastasis .
New regional anesthetic technique for modified radical mastectomy discovered recently called rhomboid intercostal nerve block that will compared against erector spinae plane block .
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The aim of this study is to compare the post-operative analgesic effect of ultrasound-guided rhomboid intercostal nerve block versus erector spinae plane block as regard total analgesic requirements, duration of effective analgesia,postoperative visual analog score (VAS), peri-operative hemodynamics,peri-operative complications and incidence of chronic postmastectomy pain.The technique of rhomboid intercostal nerve block:
After induction of anesthesia, the patient will be positioned in lateral decubitus with the operated side above. After sterilization of the patient's back, A linear ultrasound transducer (6-12 MHz) will place medial to the lower border of the scapula with the orientation marker directed cranially. The ultrasound landmarks, trapezius muscle, rhomboid muscle, intercostal muscles, pleura, and lung will be identified. The tissue plain between the rhomboid major and intercostal muscles is identified, and a single injection is administered at the T4-5. 80mm 21-gage needle will be inserted in the plane view of the ultrasound probe at the level of T4-5. After negative aspiration of blood or air, the rhomboid intercostal plane was hydro located with 2 mL of normal saline to confirm the correct needle tip position. A single injection of 30 ml of bupivacaine 0.25% will be applied into the interfacial plane between the rhomboid major and intercostal muscles. The spread of local anesthetic solution under the rhomboid muscle will be visualized by ultrasonography.
The technique of Erector spinae plane block (ESP):
After induction of anesthesia, the patient will be positioned in lateral decubitus with the operated side above. After sterilization of the patient's back, A linear ultrasound probe willplace 3-cm lateral to the midline at the level of T5 interspinous space and transverse process and three muscles willidentify: trapezius, rhomboid major, and erector spinae. A 10-cm needle was inserted craniocaudally in-plane, to reach the transverse process. After hydrodissection of the plane with 3 mL of normal saline, 30 ml of 0.25% bupivacainewilldeposit and thus erector spinae muscle will lift off the transverse process.
Block assessment will be performed using ice cube withtemperature of 4°C at midclavicular linein post anesthesia care unit after Full recovery which be confirmed when Aldrete's score ≥9 .
Block success means at least3 dermatomal segments should be having decreased sensation to cold.
Failed block will be excluded from the study and patient will replaced by another patient.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
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Mansoura, Egypt
- Mansoura University
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Dakahlia
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Mansoura, Dakahlia, Egypt, 35516
- Mansoura University
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- - Female patients aged between 25-65 years.
- ASA physical status I or II.
- Scheduled for elective unilateral modified radical mastectomy
Exclusion Criteria:
- - Patient refusal.
- Infection at the site of injection.
- Hypersensitivity to the local anesthetic
- Bleeding disorders.
- Patients with cardiac, hepatic, and renal failure.
- BMI ≥40 kg/m2
- Patient with serum cr > 1.5
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: rhomboid intercostal plane block
as in intervention description
|
- 30 mL bupivacaine 0.25% will injected ultrasound-guided in rhomboid intercostal fascial plane .
Other Names:
|
Experimental: Erector spinae plane block
As in intervention description
|
- 30 mL bupivacaine 0.25% will injected ultrasound-guided in rhomboid intercostal fascial plane .
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The total analgesic requirements during the first 24 hours postoperative.
Time Frame: 0,2,4,6,8,10,12,16,20,24 hours postoperatively
|
All patients will receive standard postoperative analgesia (1gm paracetamol every 8 hours IV).
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0,2,4,6,8,10,12,16,20,24 hours postoperatively
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The duration of effective analgesia
Time Frame: 0,2,4,6,8,10,12,16,20,24 hours postoperatively
|
time interval between the end of surgery and first analgesic request .
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0,2,4,6,8,10,12,16,20,24 hours postoperatively
|
Collaborators and Investigators
Sponsor
Investigators
- Study Director: mohamed y makharita, MD, Professor OFanesthesia Mansoura university
- Study Chair: ghada f amer, MD, Assistant professor of anesthesia Mansoura university
- Principal Investigator: ahmed E Kamal, resident, resident of anesthesia mansoura university
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Anticipated)
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
- MFM-IRB,MS.21.09.1654
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.
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