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To compare the efficacy of USG-guided bilateral Erector spinae plane block (ESPB) with intrathecal morphine (ITM) for postoperative analgesia after major hepatopancreaticobiliary surgery (HPB)
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Erector Spinae Plane Block | Active Comparator | Patients will receive Erector spinae plane block. |
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| Intrathecal morphine ITM | Active Comparator | Patients will receive Intrathecal morphine. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Erector Spinae Plane Block | Procedure | Patients will be turned into the prone position. A high-frequency linear ultrasound probe will be placed in a longitudinal parasagittal orientation 2.5-3 cm lateral to the T8 spinous process. The erector spinae muscles will be identified superficial to the tip of the T8 transverse process. After local infiltration of the needle insertion site with 2-3 ml of 2% lidocaine, a 21G 10 cm needle will be inserted using an in-plane approach in a cranial to caudal direction to contact the T8 transverse process. The location of the needle tip will be confirmed by hydrodissection with 2 mL of lidocaine 2% and visualizing linear fluid spread lifting the erector spinae muscle off the bony shadow of the transverse process on ultrasonographic imaging. A volume of 20 mL of 0.25% Bupivacaine is injected will be injected at this point. The same procedure will be repeated for the opposite side. |
| Measure | Description | Time Frame |
|---|---|---|
| Cumulative opioid consumption | Nalbuphine consumption in mg equivalent to morphine dose | 24 hours postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Nalbuphine consumption in mg | equivalent to morphine dose | at 8, 48, and 72 hours postoperatively. |
| Analgesic drug consumption other than nalbuphine | consumption in mg |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Assiut University hospital | Asyut | Asyut Governorate | 11111 | Egypt |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| Intrathecal morphine | Procedure | Patients will be placed on their right side. An intrathecal injection of morphine 200 μg (0.2 mL of morphine sulfate 1 mg/mL) diluted in 1.8 mL normal saline will be administered at the L3-L4 or L4-L5 level with a 25 G Whitacre spinal needle. |
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| at 8, 24, 48, and 72 hours postoperatively. |
| Numerical Rating Scale (NRS) at rest and when coughing | NRS is an 11-point (0=no pain and 10=worst pain) | at 1, 2, 4, 8, 12, 24, 48 and 72 hours postoperatively |
| Heart Rate | Heart Rate in beats /min | Intraoperatively |
| Mean Arterial Pressure | Mean Arterial Pressure in mmHg | Intraoperatively |
| Incidence of Postoperative nausea & vomiting (PONV) | Number of patients developing PONV | 24 hours postoperatively |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |