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The patients will be randomly allocated into two equal groups using a computer program.
Group A: will receive external oblique intercostal block after induction. Group B: will receive postoperative morphine per patient request.
General anaesthesia induction will be achieved using fentanyl 1µg/kg (IV), propofol 2mg/kg (IV), and0.5mg/kg of IV Atracurium. General anaesthesia will be maintained with mechanical ventilation with isoflurane with O2 \ Air mixture.
During anaesthesia maintenance Intraoperatively, if BP or heart rate (HR) increase more than 20% from baseline, intravenous morphine will be given to stabilize the patients' haemodynamics.
All patients will receive 1g intravenous paracetamol and 4mg ondansetron 8mg dexamethasone.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| external oblique intercostal block after induction | Active Comparator | After induction of general anesthesia, external oblique intercostal blocks will be performed with patients positioned in the supine position with their ipsilateral arm abducted. Initially the probe is placed in a cephalad to caudad paramedian direction at the anterior axillary line, and the external oblique muscle identified at the level ribs 6 and 7 in line with the xiphoid process. To confirm correct identification of the external oblique muscle, With 17gauge echogenic ultrasound needle will be advanced in plane from a superomedial-to-inferolateral direction, through the external oblique muscle.30 ml of bupivacaine 0.25% will be administered incrementally. |
|
| postoperative morphine per patient request | No Intervention | In this group no block will be done only morphine will be given intraoperatively- according to hemodynamic change and postoperative by morphine per patient request |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| external oblique intercostal block | Procedure | 20 ml of bupivacaine 0.25% will be administered by US into external oblique intercostal plane at the level of sixth rib space . |
|
| Measure | Description | Time Frame |
|---|---|---|
| Time for first rescue analgesia | hours | day 0 |
| Measure | Description | Time Frame |
|---|---|---|
| VAS score | 1 to 10 (0 is interpreted as no pain, 1-4 mild pain, 5-6 moderate pain, 7-10 severe pain) | 24 hours |
| rescue analgesics | morphine mg |
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Inclusion Criteria:
- Eligible patients will be older than 18 years old with American society of anestheologist ASA physical status I, II and III scheduled for Trans-Abdominal ( Anterior Subcostal) Nephrectomy
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| AMAL G SAFAN, MD | Menoufia University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Menoufia university | Cairo | Shibin Elkom | 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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| 24hous |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |