Transversus Abdominis Plane Block Versus Erector Spinae Plane Block
Condition: Postoperative Pain; Laparotomy
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      The TAP block, first described by Rafi in 2001, is comprised of deposition of a local
      anesthetic into the anatomical plane between the internal oblique and transverses abdominis
      muscles, where thess thoracoabdominal nerves (T6-L1) contribute to the main sensory supply of
      the skin, muscles, and parietal peritoneum of the anterior abdominal wall. These nerves
      branch and communicate extensively with each other in the TAP .

      Erector spinae plane (ESP) block is a recently described interfascial block in which the
      local anaesthectic is placed over or below the plane of the erector spinae muscle, near where
      the spinal nerves come out from the spine before they start to divide. Some publications have
      shown its effectiveness in treating thoracic and abdominal postoperative pain.

      Postoperative pain is the major obstacle for early postoperative ambulation and increases the
      risk of venous thromboembolism, respiratory complications and prolongs the hospital stay.
      Parietal pain is the chief component of postoperative pain after abdominal surgeries. Large
      doses of opioids are required to mitigate this pain, but they are poorly tolerated.
      Multimodal analgesia is effective in handling postoperative pain and in attenuating the side
      effects of large doses of a single analgesic .
    

Detailed description: 
      Group I (A group): Will undergo ESP block with 40 ml bupivacine 0.25% (20 ml on each side),
      and TAP block with 40 ml saline 0.9% (20 ml on each side).

      Group II (B group): Will undergo TAP block with 40 ml bupivacine 0.25% (20 ml on each side),
      and ESP block with 40 ml saline 0.9% (20 ml on each side).

      Group III (C group): anesthetized with the protocol followed by Minia University Hospital The
      medication will be prepared and supplied in similar syringes by an anesthetist not included
      in the management of the patint or data collection.

      Methods:

      Following placement of the standard monitors, intravenous access will secured and the
      patients will started on IV fluids. Anesthesia will be induced with 0.04 mg/kg midazolam, 2
      μg/kg fentanyl, and titrated doses of propofol. Endotracheal intubation will facilitated with
      0.5 mg/kg of atracurium. Isoflurane 1.2%, will be used for anesthetic maintenance After
      induction of anesthesia, stabilizing the patient's hemodynamics, and before surgical
      incision, ESB & TAP block will be performed. With the patient in the supine position, the
      site of the ultrasound and needle entry will be sterilized. The TAP block will be performed
      laterally behind the midaxillary line between the iliac crest and the most inferior extent of
      the ribs. The plane between the internal oblique and transversus abdominis muscle will be
      located around the midaxillary line with the probe transverse to the abdomen. Anteriorly,The
      needle will be passed to come in plane with the ultrasound beam and placed between
      transversus and internal oblique posterior to the midaxillary line then, the local anesthetic
      will be injected. Then the patient will turn in lateral position, the site of the ultrasound
      and needle entry will be sterilized. The ESP block will be performed into a fascial plane
      between the deep surface of erector spinae muscle and the transverse processes
    

Intervention name(s): transversus abdominis plane block; erector spinae plane block; control group
Intervention type(s): Procedure; Procedure; Other
Intervention description(s): The TAP block will be performed laterally behind the midaxillary line between the iliac crest and the most inferior extent of the ribs. The plane between the internal oblique and transversus abdominis muscle will be located around the midaxillary line with the probe transverse to the abdomen. Anteriorly,The needle will be passed to come in plane with the ultrasound beam and placed between transversus and internal oblique posterior to the midaxillary line then, the local anesthetic will be injected; The ESP block will be performed into a fascial plane between the deep surface of erector spinae muscle and the transverse processes; placebo
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Prevention
Keywords: Erector Spinae Plane Block; Transversus Abdominis Plane Block