U/s Guided Oblique Subcostal Transversus Abdominis Plane Block Versus Erector Spinae Plane Block as Preemptive Analgesia
Condition: Pain; Hernia, Umbilical
MeSH terms: Hernia, Umbilical; Hernia
Study type: Interventional
Phase: Phase 4

Summary: 
      Administration of opioids for the treatment of acute pain after open umbilical hernia repair
      is associated with many side effects. Erector spinae plane (ESP) block is a novel
      inter-fascial plane block used in postoperative pain and chronic neuropathic pain relief of
      the thoracoabdominal region.TAP block is a regional injection of local anaesthetic between
      the transversus abdominis and internal oblique muscle planes. TAP block affects the sensory
      nerves of the anterolateral abdominal wall (T6-L1) that innervate the abdomen.
    

Detailed description: 
      TAP block is a regional injection of local anaesthetic between the transversus abdominis and
      internal oblique muscle planes. TAP block affects the sensory nerves of the anterolateral
      abdominal wall (T6-L1) that innervate the abdomen. TAP block is an easy technique and
      decreases postoperative pain and opioid consumption.

      Erector spinae plane (ESP) block is a novel inter-fascial plane block used in postoperative
      pain and chronic neuropathic pain relief of the thoracoabdominal region. However, its first
      use was for the treatment of chronic pain, but recently it has been used as a postoperative
      regional analgesia technique in different surgeries from the shoulder to hip regions (3-4)
      The present study will be carried out to compare the preemptive analgesic efficacy between
      the ultrasound-guided bilateral ESP block versus bilateral oblique subcostal TAP block on
      patients undergoing open umbilical hernia repair.
    

Intervention name(s): Bupivacain; Bupivacaine
Intervention type(s): Drug; Drug
Intervention description(s): Ultrasound-guided oblique subcostal transversus abdominis plane block will be performed in the supine position under strict aseptic precautions. placing a linear high-frequency ultrasound probe obliquely near the costal margin and xiphoid process On confirming the placement of the needle in the correct target space, 1 mL of 0.25% bupivacaine will be injected to hydro-dissect the fascia layer between the RA and TA. After confirming the separation of the transversus abdominis fascia plane, the remaining 19 mL of 0.25% bupivacaine will be administered, advancing the needle infero-laterally parallel to the subcostal margin. A similar procedure will be performed on the contralateral side of the abdomen with an injection of another 20 mL of 0.25% bupivacaine.; Ultrasound-guided erector spinae plane block will be performed in the sitting position. T7 spinous process will be located To perform the block. The tip of the T7 transverse process will be then identified using the ultrasound probe that is placed in a transverse orientation The ultrasound transducer will then be placed in a longitudinal orientation 2-3 cm lateral to the midline in a longitudinal orientation to identify the hyperechoic line of the transverse process with its associated acoustic shadow. After local anaesthetic infiltration, the block needle will be inserted in a craniocaudal direction until contact will be achieved with the T 7 transverse process where the tip will lay in the inter-fascial plane below the erector spinae muscle. A small bolus of local anaesthetic should be given through the block needle to confirm the proper needle position. A total of 20 mL bupivacaine 0.25% will be injected into the interfacial plane deep to the erector spinae muscle bilaterally.
Other intervention name(s): oblique subcostal transversus abdominis plane block; erector spinae plane block
Intervention MeSH terms: Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Open umbilical hernia; Transversus abdominis plane block; Erector spinae plane block