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The aim of this work is to compare the efficacy and safety of the effectiveness and safety of ultrasound-guided surgical rectus sheath block and local anesthetic infiltration for postoperative analgesia in patients undergoing total abdominal hysterectomy.
Total abdominal hysterectomy (TAH) is a commonly performed major surgical procedure that results in substantial postoperative pain and discomfort.
Local anesthetic infiltration (LAI) at the end of surgery is one of the most common technique employed in laparotomies for postoperative analgesia.
Rectus sheath block (RSB) has been used as a part of multimodal analgesia, especially when neuraxial techniques are unsuitable.The RSB was used to achieve peri-operative relaxation of the anterior abdominal wall.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ultrasound-guided rectus sheath block group | Experimental | Patients will receive ultrasound-guided rectus sheath block (20 ml bupivacaine 0.25%) bilaterally at the end of surgery. |
|
| Surgical rectus sheath block group | Experimental | Patients will receive a surgical rectus sheath block (20 ml bupivacaine 0.25%) bilaterally at the time of closure. |
|
| Local anesthesia infiltration group | Experimental | Patients will receive local anesthesia infiltration at the end of surgery. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ultrasound-guided rectus sheath block | Drug | Patients will receive ultrasound-guided rectus sheath block (20 ml bupivacaine 0.25%) bilaterally at the end of surgery. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Total morphine consumption | Rescue analgesia of morphine will be given as 3 mg bolus if the Visual Analogue Scale (VAS)> 3 to be repeated after 30 min if pain persists until the VAS < 4. | 24 hours postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Heart rate | Heart rate will be recorded preoperatively, before the block is performed, and every 15 minutes until the end of the surgery. | Till the end of surgery (Up to 4 hours) |
| Mean arterial pressure |
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Inclusion Criteria:
Exclusion Criteria:
Women scheduled for elective total abdominal hysterectomy
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Sarah A Afifi, MD | Contact | 0501035864 | Sarah606060@gmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ain Shams University | Recruiting | Cairo | 11591 | Egypt |
The data will be available upon a reasonable request from the corresponding author after the end of study for one year.
After the end of study for one year.
The data will be available upon a reasonable request from the corresponding author.
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|
| Surgical rectus sheath block | Drug | Patients will receive a surgical rectus sheath block (20 ml bupivacaine 0.25%) bilaterally at the time of closure. |
|
|
| Local anesthesia infiltration | Drug | Patients will receive local anesthesia infiltration at the end of surgery. |
|
|
Mean arterial pressure will be recorded preoperative, before performing of block, and every 15 min till the end of surgery.
| Till the end of surgery (Up to 4 hours) |
| Time to the first request for the rescue analgesia | Time to the first request for the rescue analgesia (time from end of surgery to first dose of morphine administrated). | 24 hours postoperatively |
| Degree of pain | Each patient will be instructed about postoperative pain assessment with the Visual Analogue Scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS will be assessed at PACU, 2, 4, 6, 12, 18, and 24h postoperatively. | 24 hours postoperatively |
| Degree of patient satisfaction | Degree of patient satisfaction will be assessed on a 5-point Likert scale patient satisfaction (1, extremely dissatisfied; 2, unsatisfied; 3, neutral; 4, satisfied; 5, extremely satisfied). | 24 hours postoperatively |
| Incidence of adverse events | Incidence of adverse events such as hematoma, nerve damage or neuropathy, bradycardia, hypotension, nausea, vomiting, pruritis, urinary retention, or any other complication will be recorded. | 24 hours postoperatively |
| ID | Term |
|---|---|
| D002045 | Bupivacaine |
| D000772 | Anesthesia, Local |
| ID | Term |
|---|---|
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
| D000588 | Amines |
| D000765 | Anesthesia, Conduction |
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |
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