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All patients admitted in National Cancer institute, Cairo University for breast surgeries will be investigated for inclusion criteria in the current study. And will be enrolled if fulfilled the criteria into 2 groups
.70 patients will be included in this prospective randomized study. The patients will be allocated into two groups: the ESPB group (group E, n = 35) , and the paravertebral group (group P, n =35)
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Erecto Spinae Plane Block group | Active Comparator | a high-frequency linear ultrasound transducer will be placed in a longitudinal orientation 3 cm lateral to the T7 spinous process. This should reveal three muscles superficial to the hyperechoic transverse process shadow as follows: trapezius, rhomboid major, and erector spinae. The skin will be anaesthetized using 3ml of 2% Lidocaine. A 20-gauge block needle will be inserted in-plane in a cephalad-to-caudad direction to place the tip into the fascial plane on the deep (anterior) aspect of erector spinaemuscle;20ml bupivacaine 0.25% will be injected. The location of the needle tip will be confirmed by visible fluid spread lifting erector spinae muscle off the bony shadow of the transverse process The needle will be removed and the catheter secured with adhesive. |
|
| the paravertebral group | Active Comparator | After identification of the transverse process, internal intercostal membrane (IIM), and pleura at the T3 and T6 levels, an out-of-plane needle guidance technique was used to perform the PVB.The success of both blocks will be confirmed by loss of pinprick sensation on the dermatomal site of the block •blocks will be activated ,After negative aspiration, 0.5 ml/kg 0.25% bupivacaine (max 20 ml) will be injected. Afterwards, a 20 gauge peripheral nerve catheter will be easily threaded into the space. The needle will be removed and the catheter secured with adhesive. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ERECTOR SPINAE PLANE BLOCK and PARAVERTEBRAL BLOCK: | Procedure | catheter will be placed for ERECTOR SPINAE PLANE BLOCK |
|
| Measure | Description | Time Frame |
|---|---|---|
| Total 48 hours Post-operative opioid consumption to keep VAS score ≤4. | the VAS score rating, in which 0 = "no pain" and 10 = "worst possible pain". both during rest and movement | 48 hours postoperative |
| Measure | Description | Time Frame |
|---|---|---|
| 1st request of analgesia | 1st request of analgesia , any hemodynamic instability and complications | 48 hours postoperative |
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Inclusion Criteria:
.Physical status ASA II.
. Patients (age 20-70yrs) scheduled for breast surgeries for breast cancer under general anesthesia
Exclusion Criteria:
.History of psychological disorders.
female post mastectomy
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| suzan adlan, lecturer | Contact | 01111068300 | dr_s.adlan@hotmail.com | |
| Taher saed, lecturer | Contact | 01225358877 | dr.taherthabet@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| suzan adlan, lecturer | National Cancer Institute, Egypt | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| NCIEgypt | Recruiting | Cairo | 11796 | Egypt |
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An independent observer who will be blind to the group assignment checked the intraoperative and postoperative data also patient will be be blinded also
| PARAVERTEBRAL BLOCK: | Procedure | catheter will be placed for PARAVERTEBRAL BLOCK |
|
| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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