Erector Spinae Block Analgesia Clinical Trial
Official title:
The Analgesic Efficacy of Erector -Spinae Technique With Levobupvicaine in Patients Undergoing Upper Abdominal Cancer Surgery
To study analgesic efficacy &safety of bilateral erector spinae block for upper abdominal cancer surgery as apart of multimodal analgesia.
Patients will be randomly assigned using computer generated randomization program
(http://www.randomizer.org) into two groups, each group of the them consist of 15 patients:
GROUP (A): {CONTROL GROUP} Patient will receive 20 ml of normal saline into interfascial
plane between rhomboidus major &erector spinae muscle bilaterally at level thoracic spine
T7,10 ml each side .
Group (B):
Patient will receive 20 mg 0.25% Levobupivacaine bilaterally as above 10 mg each side.
Preoperatively & post-operatively procedures:
Premedication will be given after complete fasting hours &after applying standard monitors
(non invasive blood pressure, pulse oximetery, ECG, temperature and capnography, an
intra-venous 16 gauge cannula will be inserted and secured).
Ultrasound guided Erector spinae plane block with patient in the sitting position & skin of
the upper back is prepared with 2% chlorhexidine solution. Counting down from c7,the spine of
T7 is identified it is corresponding to the tip the scapular spine ,a high frequency
ultrasound probe is placed across T7 spine then probe move slowly laterally to identify
transverse process of T7 ,So probe is moved to a vertical alignment and erector spinae muscle
is visualized lying underneath the trapezius muscle.
Needle gauge will be inserted then 10 ml Levobupivacaine into interfascial plane between
rhomboid major & erector spinae muscle in each side.
General anesthesia will be induced with Fentanyl 0.5 μg/kg, Propofol 2mg/kg, muscle relaxant
(Atracurium 0.5 mg /kg) , inhalational anesthesia ( Isoflurane 1-1.5 MAC-or-sevoflurane2-3MAC
) as maintenance of anesthesia with frequent muscle relaxant every 20 minutes to maintain
heart rate (HR) and blood pressure within 20% of the basal value. Patients were mechanically
ventilated to maintain end tidal (ETCO2) between 35-40 mmHg. The inspired oxygen fraction
(FIO2) was 0.5 using oxygen-and-air mixtures with frequent monitoring intraoperatively every
30 minutes, IV fentanyl infusion at rate of 0.1 μg/kg/hr may be used if needed.
Non steroidal anti-inflammatory as ketobrufen will be given intraoperatively at dose of
(0.5-0.75mg/kg)then postoperatively every eight hours at the same dose.
The reverse of muscle relaxant with safe extubation will be done at the end of surgery.
-PCA morphine 2mg within five minutes lock out interval will be given postoperatively when
there is pain.
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