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This study aims to compare ultrasound-guided subtransverse process interligamentary (STIL) block versus thoracic paravertebral block (TPVB) for postoperative analgesia in patients undergoing open nephrectomy.
Acute pain physiopathology is explained as it is mediated by inflammatory cell infiltration, activation of spinal cord pain pathways, and also by reflexive muscle spasm. All of these three mechanisms of acute pain are typically ameliorated during the postoperative recovery.
A thoracic paravertebral block (TPVB) shows comparable analgesic efficacy with fewer side effects compared with thoracic epidural analgesia in patients undergoing thoracotomy.
The recently introduced subtransverse process interligamentary (STIL) block offers a safer alternative by targeting thoracic nerves without entering paravertebral space.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| STIL group | Experimental | Patients will receive subtransverse process interligamentary (STIL) block using 20ml of bupivacaine 0.25%. |
|
| TPVB group | Experimental | Patients will receive a thoracic paravertebral block (TPVB) using 20ml of bupivacaine 0.25%. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Subtransverse process interligamentary | Other | Patients will receive subtransverse process interligamentary (STIL) block using 20ml of bupivacaine 0.25%. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Total morphine consumption | Rescue analgesia of morphine will be given as 3 mg bolus if the numeric rating scale (NRS) > 3 to be repeated after 30 min if pain persists until the NRS < 4. | 48 hours postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Time to the 1st rescue analgesia | Time to the first request for the rescue analgesia will be recorded from the end of surgery to first dose of morphine administrated. | 48 hours postoperatively |
| Intraoperative fentanyl consumption |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Tanta University | Tanta | El-Gharbia | 31527 | 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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| Thoracic paravertebral block | Other | Patients will receive a thoracic paravertebral block (TPVB) using 20ml of bupivacaine 0.25%. |
|
Additional fentanyl bolus dosages of 0.5 µg/kg IV will be administered if heart rate or mean arterial blood pressure elevated more than 20% of the baseline (after exclusion of other causes than pain).
| Intraoperatively |
| Mean arterial pressure | Mean arterial pressure will be recorded preoperatively, before performing the block, and every 15 min till the end of surgery. | Till the end of surgery (Up to 2 hours) |
| Heart rate | Heart rate will be recorded preoperatively, before performing the block, and every 15 min till the end of surgery. | Till the end of surgery (Up to 2 hours) |
| Degree of pain | Each patient will be instructed about postoperative pain assessment with the numeric rating scale (NRS) score. NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). NRS will be assessed at PACU, 2, 4, 6, 8, 12, 18, 24, 36, and 48 h postoperatively. | 48 hours postoperatively |
| Incidence of adverse events | Incidence of adverse events such as pneumothorax, local anesthetic systemic toxicity (LAST), bradycardia, hypotension, nausea, vomiting, respiratory depression, pruritus, or any other complication will be recorded. | 48 hours postoperatively |