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| Name | Class |
|---|---|
| Mohamed, Ahmed A., M.D. | INDIV |
| Laila Halim Doss | UNKNOWN |
| Ahmed Zaghloul Fouad | UNKNOWN |
| Michael Zarif Sobhy |
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The investigators hypothesize that the analgesic efficacy of ultrasound-guided serratus anterior plane block will provide better analgesia with fewer complications in comparison to ultrasound guided thoracic paravertebral block
•The blocks techniques:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group I: | Active Comparator | These patients will receive single ipsilateral Ultrasound TPVB which performed with the patient in the sitting position at the level of the T4 with the probe in a vertical position 2.5-3 cm lateral to the midline. The midpoint of the transducer is to be placed in a longitudinal paramedian plane between two transverse processes which visualized with the superior costo-transverse ligament and the pleura visible in between . After this, 15-20 cc of bupivacaine 0.25% will be injected |
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| Group II : | Active Comparator | These patients will receive serratus anterior plane block. The block will be performed while the patient is in the supine position by using a linear Ultrasound probe of high frequency (6-13 MHz) after sheathing. The probe will be placed over the mid-clavicular region of the thoracic cage in a sagittal plane. The ribs will be counted inferiorly and laterally, until the 5th rib is identified in the midaxillary line. The latissimus dorsi (superficial and posterior) , teres major (superior) and serratus muscles (deep and inferior) will be then easily identifiable by U/S overlying the fifth rib. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Thoracic paravertebral block(TPVB) group | Procedure | Thoracic paravertebral block group (TPVB) group: The midpoint of the transducer is to be placed in a longitudinal paramedian plane between two transverse processes.Tuohy needle will be introduced in a cephalad direction. The tip of the needle will be advanced under direct visualization until it pierces the superior costo-transverse ligament. When the needle tip is located immediately above the pleura, the needle is aspirated to confirm the absence of blood or air. Serratus anterior plane block group (SAP) group: The US probe will be placed over the mid-clavicular region of the thoracic cage in a sagittal plane. The ribs will be counted until the 5th rib is identified in the midaxillary line. The latissimus dorsi, teres major and serratus muscles will be then easily identifiable by US overlying the fifth rib. The needle will be introduced in-plane with respect to the US probe from supero-anterior to postero-inferior |
| Measure | Description | Time Frame |
|---|---|---|
| First pain medication request | Time to the first pain medication request till application of the block | 24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Time of pain onset | Time of onset of Pain | 24 hours |
| Hemodynamics (heart rate) | Hemodynamics in the form of heart rate "beats per minute" |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ahmed Abdalla, M.D | Cairo University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ahmed Abdalla Mohamed | Cairo | 11451 | Egypt | |||
| Kasr Alainy Hospitals |
Via scholar Gate
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| UNKNOWN |
Although thoracic epidural analgesia is the gold standard technique after breast surgery paravertebral block (PVB) has become a potential alternative approach. However, both techniques may be associated with serious complications such as pneumothorax, total spinal anaesthesia and inadvertent intravascular injection. Recently since the advent of ultrasound (US) in anaesthetic practice several interfascial plane blocks have been described. Serratus plane block is a novel interfascial plane block which can provide analgesia after breast surgery.
The serratus anterior plane block is an interfascial plane block where the local anaesthetics are injected superficial to serratus anterior at the 5th rib level in the mid axillary line. The serratus plane block is a progression from Blanco's et al work with the Pecs I and II blocks by making the technique easier in its application using single injection and to lower the potential side-effects
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•Patients will be randomly allocated to one of the two groups by sealed closed envelop technique
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|
| 24 hours |
| Hemodynamics (ABP) | Hemodynamics in the form of arterial blood pressure" mm Hg". | 24 hours |
| Nausea and vomiting | Postoperative nausea and vomiting | 24 hours |
| Cairo |
| 11451 |
| Egypt |
| ID | Term |
|---|---|
| D044382 | Population Groups |
| ID | Term |
|---|---|
| D003710 | Demography |
| D011154 | Population Characteristics |
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