Postoperative Pain Clinical Trial
Official title:
Postoperative Analgesic Efficacy of Transversus Abdominis Plane Block by Bupivacaine With Two Different Concentrations in Pediatric Patient Undergoing Laparoscopic Surgery
The primary objective of this study is to assess differences in postoperative pain experienced by pediatric patients having transversus abdominis plane block block with bupivacaine (0.125% and 0.25%) compared with control group will receive conventional iv analgesia after Laparoscopic surgery.
A prospective randomized controlled double blind study using a computer generated
randomization will be conducted in Assiut University Hospitals and carried on 60 pediatric
patients undergoing laparoscopic surgery under general anesthesia.
After induction of general anesthesia and endotracheal intubation, patients in group B and
group C will be placed in the supine position and transversus abdominis plane block will be
performed under ultrasound guidance. After skin preparation, the linear ultrasound probe
connected to a portable ultrasound unit will be placed in the axial plane across the
mid-axillary line midway between the costal margin and the highest point of iliac crest.
needle attached to a syringe filled with the Local anesthetic solution will be inserted until
it reaches the plane between the internal oblique and transversus abdominis muscles.
After careful aspiration to exclude vascular puncture, injection of bupivacaine will be
performed leading to separation between the internal oblique and the transversus abdominis
muscles which will appear as a hypoechoic space on ultrasound. This procedure will be
repeated on the opposite side .
Laparoscopic procedure will be started 20 minutes after completion of bilateral transversus
abdominis plane block and 0.01 mg/kg iv atropine will be given before pneumoperitonem. Intra
abdominal pressure will be maintained at 10-12 mmHg.
The use of opioids during the procedure will based on the cardiovascular response to
stimulation; a heart rate increase of 20% from baseline will be interpreted as insufficient
analgesia and will be treated with fentanyl in doses of 1mcg / kg.
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