Due to the significant risk of massive bleeding complicated by profound hypotension and coagulopathy and a high likelihood of hysterectomy during caesarean delivery, general anesthesia is generally regarded as the anesthetic of choice for patients with placenta accreta. The advantage of a planned general anesthetic is the ability to secure the airway in a controlled setting, before the onset of hemodynamic instability, airway edema or coagulopathy. A multidisciplinary approach may improve patient outcomes. However, it is necessary to maintain a good depth of anesthesia and sufficient analgesia and to consider the impact of anesthesia drugs on the fetus.
Since all opioids, particularly those with high lipid solubility (e.g., remifentanil, fentanyl, and sufentanil), readily pass through the placenta to the fetus. Consequently, opioid administration is usually avoided until after delivery to reduce the risk of neonatal depression.
The latest publications have reported that the erector spinae plane block is one of the components of multimodal analgesia techniques for pain management after different surgical procedures, including cesarean delivery.
Inclusion Criteria:
American Society of Anesthesiologists physical status II.
Exclusion Criteria:
• Patient's unwillingness to participate in the study.
bilateral ESPB with general anesthesia. block will be performed under ultrasound guidance 30 minutes before induction of general anesthesia . After standard disinfection of skin and subcutaneous infiltration of 3 mL of 2% lidocaine, a 22G blunt needle will be introduced from the outside towards the transverse process (T9) using the in-plane method until the needle tip crosses all the muscles. Subsequently, 20 ml of 0.25% Bupivacaine will be injected between the transverse process and the deep surface of the erector spinae on each side. thus the expected dermatomal block would be from T5 to L1. Testing for loss of tactile sensation and discrimination in the expected dermatome will be done 20 min after the injection of drugs. If no loss of sensation was attained within 30 min this will be considered an unsuccessful block and the parturient will be excluded from the study and managed according to the theater protocol.
general anesthesia with opioids. Patients in this group will be given 1mic/kg fentanyl diluted to 10 ml by IV injection by the attending anesthetist after delivery of the fetus. General anesthesia will be induced in both groups after adequate preoxygenation using propofol 2.5 mg/kg, rocuronium 1 mg/kg. After securing the endotracheal tube (6.5mm), anesthesia will be maintained using 1 MAC isoflurane, timed rocuronium and volume-controlled ventilation 6-8ml/kg to obtain normocarbia.
Cairo, Egypt
Postoperative Analgesia After Cesarean Section; Comparison Among Ultrasound Guided Erector Spinae, Quadratus Lumborum or Transversus Abdominis Plane Blocks
Comparison of Combined Spinal Epidural Analgesia and Erector Spinae Plane Block After Elective Cesarean Section
Erector Spinae Plane Versus Transversus Abdominis Plane Block for Pain Control
The Analgesic Efficacy of Bilateral Erector Spinae Plane Block in Comparison With Intrathecal Morphine After Elective Cesarean Section