Breast Cancer Clinical Trial
Official title:
The Effectiveness of Pain Relieve of Ultrasound-guided Erector Spinae Plane Block Versus Serratus Anterior Plane Block With General Anesthesia in Modified Radical Mastectomy Patient (Randomized Double-Blinded Controlled Clinical Trial)
NCT number | NCT03579524 |
Other study ID # | M336 |
Secondary ID | |
Status | Completed |
Phase | N/A |
First received | |
Last updated | |
Start date | August 1, 2018 |
Est. completion date | September 15, 2019 |
Verified date | November 2020 |
Source | Fayoum University Hospital |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Breast cancer is by far the world's most common cancer among women and the most common cause of female death from cancer worldwide. It's worldwide incidence is 43.4 in 100.000 while in Egypt is 48.8 in 100.000. One of the most common surgical procedures for it is modified radical mastectomy (MRM), It is account for 31% of all breast surgery cases. Post-mastectomy pain is a big problem affecting the outcome of surgery. It was used to be managed by opioids which may lead to many side effects such as nausea, vomiting, ileus, over sedation and respiratory depression. Chronic pain syndrome (phantom breast pain, paraesthesias, and intercostobrachial neuralgia) may be developed due to inadequate pain control. So many regional analgesic techniques have been developed for effective pain control. The safest and easiest is local wound infiltration with local anesthesia but the duration of action is limited. Intercostal nerve block and interpleural block are effective, but there is a fear of pneumothorax and transient Horner's syndrome. Thoracic epidural analgesia is not preferred however it's efficacy because of possible neurological and hemodynamic side effects. The gold standard now is thoracic paravertebral block (PVB) which provide effective analgesia with minimal hemodynamic derangement but it carries a risk of pneumothorax in addition to slightly complex technique. Ultrasound-guided interfascial plane blocks such as pectoral nerve (PECS) block type 1 and 2 , serratus anterior plane block (SAPB) and erector spinae plane block (ESP) which is a recent block newly described for various surgeries for postoperative analgesia have also been reported as alternatives, with the advantages of simplicity, ease of performance and fewer complications. there is no sufficient Randomized controlled trails that assess the effectiveness and safety of erector spinae plane block ESPB in controlling post mastectomy pain This study compares the analgesic efficacy of ultrasound-guided erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) in patients undergoing MRM with axillary dissection.
Status | Completed |
Enrollment | 62 |
Est. completion date | September 15, 2019 |
Est. primary completion date | August 15, 2019 |
Accepts healthy volunteers | No |
Gender | Female |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - female aged >18 years with breast cancer eligible for modified radical mastectomy. - American Society of Anesthesiologists Physical Status I to IV. Exclusion Criteria: - Patient refusal. - body mass index (BMI) > 40. - local infection at the site of the block. - local anesthetic allergy. - significant neurological or respiratory disease. |
Country | Name | City | State |
---|---|---|---|
Egypt | Fayoum University hospital | Madinat al Fayyum | Faiyum Governorate |
Lead Sponsor | Collaborator |
---|---|
Fayoum University Hospital |
Egypt,
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Bonvicini D, Giacomazzi A, Pizzirani E. Use of the ultrasound-guided erector spinae plane block in breast surgery. Minerva Anestesiol. 2017 Oct;83(10):1111-1112. doi: 10.23736/S0375-9393.17.12015-8. Epub 2017 May 11. — View Citation
Bonvicini D, Tagliapietra L, Giacomazzi A, Pizzirani E. Bilateral ultrasound-guided erector spinae plane blocks in breast cancer and reconstruction surgery. J Clin Anesth. 2018 Feb;44:3-4. doi: 10.1016/j.jclinane.2017.10.006. Epub 2017 Oct 21. — View Citation
Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016 Sep-Oct;41(5):621-7. doi: 10.1097/AAP.0000000000000451. — View Citation
Gupta K, Srikanth K, Girdhar KK, Chan V. Analgesic efficacy of ultrasound-guided paravertebral block versus serratus plane block for modified radical mastectomy: A randomised, controlled trial. Indian J Anaesth. 2017 May;61(5):381-386. doi: 10.4103/ija.IJA_62_17. — View Citation
Kimachi PP, Martins EG, Peng P, Forero M. The Erector Spinae Plane Block Provides Complete Surgical Anesthesia in Breast Surgery: A Case Report. A A Pract. 2018 Oct 1;11(7):186-188. doi: 10.1213/XAA.0000000000000777. — View Citation
Matsumoto M, Flores EM, Kimachi PP, Gouveia FV, Kuroki MA, Barros ACSD, Sampaio MMC, Andrade FEM, Valverde J, Abrantes EF, Simões CM, Pagano RL, Martinez RCR. Benefits in radical mastectomy protocol: a randomized trial evaluating the use of regional anesthesia. Sci Rep. 2018 May 18;8(1):7815. doi: 10.1038/s41598-018-26273-z. — View Citation
Veiga M, Costa D, Brazão I. Erector spinae plane block for radical mastectomy: A new indication? Rev Esp Anestesiol Reanim. 2018 Feb;65(2):112-115. doi: 10.1016/j.redar.2017.08.004. Epub 2017 Nov 2. English, Spanish. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | The duration of analgesia of the two blocks | the pain will be assisted based on the time needed for the first dose rescue analgesia. | At 48 hours postoperative | |
Secondary | The cumulative opioids (morphine) consumption | The total amount of opioids received post operative | At 24 hours postoperative | |
Secondary | The cumulative opioids (morphine) consumption | The total amount of opioids received post operative | At 48 hours postoperative | |
Secondary | The intervals between opioid (morphine) doses | the time needed between two successive opioid doses | At 24 hours postoperative | |
Secondary | The intervals between opioid (morphine) doses | the time needed between two successive opioid doses | At 48 hours postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at rest | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At one hour postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at rest | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At 6 hours postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at rest | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At 12 hours postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at rest | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At 18 hours postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at rest | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At 24 hours postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at rest | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At 30 hours postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at rest | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At 36 hours postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at rest | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At 42 hours postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at rest | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At 48 hours postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at arm abduction | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At one hour postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at arm abduction | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At 6 hours postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at arm abduction | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At 12 hours postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at arm abduction | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At 18 hours postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at arm abduction | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At 24 hours postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at arm abduction | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At 30 hours postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at arm abduction | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At 36 hours postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at arm abduction | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At 42 hours postoperative | |
Secondary | The quality of analgesia based on visual analogue scale (VAS) pain score at arm abduction | the quality of analgesia between (0-100 mm) where 0=no pain and 100 = worst comprehensible pain | At 48 hours postoperative | |
Secondary | Incidences of complications related to both techniques | complications related to the Block or drug administered | up to 72 hours postoperative | |
Secondary | Nausea | Morphine related side effect | At 2 hours postoperative | |
Secondary | Nausea | Morphine related side effect | At 6 hours postoperative | |
Secondary | Nausea | Morphine related side effect | At 12 hours postoperative | |
Secondary | Nausea | Morphine related side effect | At 24 hours postoperative | |
Secondary | Nausea | Morphine related side effect | At 48 hours postoperative | |
Secondary | Nausea | Morphine related side effect | At 72 hours postoperative | |
Secondary | Vomiting | Morphine related side effect | At 2 hours postoperative | |
Secondary | Vomiting | Morphine related side effect | At 6 hours postoperative | |
Secondary | Vomiting | Morphine related side effect | At 12 hours postoperative | |
Secondary | Vomiting | Morphine related side effect | At 24 hours postoperative | |
Secondary | Vomiting | Morphine related side effect | At 48 hours postoperative | |
Secondary | Vomiting | Morphine related side effect | At 72 hours postoperative | |
Secondary | Pruritus | Morphine related side effect | At 2 hours postoperative | |
Secondary | Pruritus | Morphine related side effect | At 6 hours postoperative | |
Secondary | Pruritus | Morphine related side effect | At 12 hours postoperative | |
Secondary | Pruritus | Morphine related side effect | At 24 hours postoperative | |
Secondary | Pruritus | Morphine related side effect | At 48 hours postoperative | |
Secondary | Pruritus | Morphine related side effect | At 72 hours postoperative | |
Secondary | Over-sedation | Morphine related side effect | At 2 hours postoperative | |
Secondary | Over-sedation | Morphine related side effect | At 6 hours postoperative | |
Secondary | Over-sedation | Morphine related side effect | At 12 hours postoperative | |
Secondary | Over-sedation | Morphine related side effect | At 24 hours postoperative | |
Secondary | Over-sedation | Morphine related side effect | At 48 hours postoperative | |
Secondary | Over-sedation | Morphine related side effect | At 72 hours postoperative | |
Secondary | Urine retension | Morphine related side effect | At 2 hours postoperative | |
Secondary | Urine retension | Morphine related side effect | At 6 hours postoperative | |
Secondary | Urine retension | Morphine related side effect | At 12 hours postoperative | |
Secondary | Urine retension | Morphine related side effect | At 24 hours postoperative | |
Secondary | Urine retension | Morphine related side effect | At 48 hours postoperative | |
Secondary | Urine retension | Morphine related side effect | At 72 hours postoperative | |
Secondary | The duration of surgery | time needed to perform surgery | Once at completion of surgery | |
Secondary | Intraoperative fentanyl needed | The amount of Fentanyl given intraoperative as fentanyl will be given when either heart rate or NIBP(Non-Invasive Blood Pressure) report an increase by more than 20% of the basal records | Once at completion of surgery | |
Secondary | Patients' satisfaction with postoperative analgesia | Will be evaluated according to a satisfaction score (poor = 0; fair = 1; good = 2; excellent= 3) | after 72 hours postoperative | |
Secondary | Age | In years | Once the patient is recruited | |
Secondary | weight | In kilograms | Once the patient is recruited | |
Secondary | Height | In meters | Once the patient is recruited | |
Secondary | BMI | In kilogram per square meter | Once the patient is recruited |
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