Subcostal Transversus Abdominis Plane Versus Epidural Block in Abdominal Surgeries
Condition: Upper Abdominal Surgery
Study type: Interventional

Summary: 
      The investegators aimed to compare the efficacy of subcostal Transversus abdominis plane
      analgesia, to epidural analgesia intra and postoperatively in upper abdominal surgeries.
    

Detailed description: 
      Epidural analgesia, once considered the gold standard for major abdominal surgeries, but is
      often associated with sympathetic blockade that creates hypotension and could therefore
      adversely affect the conduit. Epidural analgesia is recently replaced by other techniques
      with an improved risk benefit ratio. Pain management techniques that use peripheral nerve
      blockade are becoming more prevalent, reducing the need for an epidural. Transversus
      abdominis plane (TAP) approach is aimed to access the nerves in this neurofacial plane
      between internal oblique muscle and transversus abdominis through the lumbar triangle of
      Petit. Subcostal Transversus abdominis plane block, has been reported to provide analgesia
      for incisions extending above the umbilicus. However, there have been few clinical trials on
      the analgesic efficacy of continuous subcostal Transversus abdominis plane analgesia after
      major abdominal surgeries. It has been reported recently that supplemental magnesium has a
      role in providing perioperative analgesia, because this is a relatively harmless molecule,
      not expensive and because the biological basis for its potential antinociceptive effect is
      promising. No clinical studies have examined the effect of magnesium sulphate administered
      continuously in subcostal Transversus abdominis plane catheters as an adjunct to bupivacaine
      in postoperative analgesia.

      The aim of this study is to compare the efficacy of subcostal Transversus abdominis plane
      analgesia, to epidural analgesia in major upper abdominal surgeries.
    

Intervention name(s): Subcostal Transversus Abdominis Plane catheter; Epidural catheter
Intervention type(s): Other; Other
Intervention description(s): Prior to surgery, an ultrasound guided unilateral Subcostal Transversus abdominis plane bolus dose (consisting of amixture of 10 ml bupivaccaine 0.5% plus 100 mg magnesium sulphate to be completed by normal saline to a total volume of 20 ml mixture) will be given on the same side of the surgical incision.
At the end of surgery, A Transversus abdominis plane catheter will be inserted unilaterally by surgeon during wound closure. Then postoperatively, Transversus abdominis plane infusion of a solution mixture prepared in multiple 50 cm syringes each syringe contain 20 ml bupivacaine 0.5% plus 100 mg magnesium sulphate to be balanced by normal saline to 50 ml solution mixture ( final concentration of bupivacaine is 0.2%). This solution mixture will be infused through Transversus abdominis plane catheter at a rate of 6 ml/hour for 72 hours postoperatively.; Prior to surgery, we will site an epidural catheter in the thoracic T7-T9 region, and inject an epidural bolus dose same as described above (consisting of amixture of 10 ml bupivaccaine 0.5% plus 100 mg magnesium sulphate to be completed by normal saline to a total volume of 20 ml mixture) for intra operative analgesia.
Postoperatively, patients will receive epidural infusion of the solution mixture (same as described above) prepared in multiple 50 cm syringes each syringe contain 20 ml bupivaccaine 0.5% plus 100 mg magnesium sulphate to be balanced by normal saline to 50 ml solution mixture ( final concentration of bupivaccaine is 0.2%). This solution mixture will be infused epidurally at a rate of 6 ml/hour for 72 hours (3 days) postoperatively.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Double blind (participant, investigator) study
Masking: Double (Participant, Investigator)
Primary purpose: Supportive Care