Bilateral Ultrasound Guided ESP Block Versus TAP Block on Post-operative Analgesia After Total Abdominal Hysterectomy
Condition: Post-operative Analgesia
MeSH terms: Agnosia
Study type: Interventional

Summary: 
      -  Abdominal hysterectomy is an open surgical procedure associated with considerable
           post-operative pain. Narcotics are often required during patient recovery but can result
           in adverse side effects. Transversus abdominis plane block(TAP block) is a regional
           anesthetic technique that is found to be effective as post-operative analgesia after
           total abdominal hysterectomy. Recently, erector spinae plane block(ESP)block is found to
           be safe, and simple regional anesthetic technique that decrease total opioid consumption
           in patient undergoing breast, or abdominal surgery.

        -  The aim is to compare the efficacy of bilateral erector spinae plane block, and
           bilateral transversus abdominis plane block on postoperative analgesia in patients after
           abdominal hysterectomy under general anesthesia, and their need for opioid.

      Hypothesis

        -  Null hypothesis (H0): No difference between the analgesic effects of bilateral erector
           spinae plane block, and bilateral transversus abdominis plane block in patients after
           abdominal hysterectomy under general anesthesia.

        -  Alternative hypothesis (H1): There are difference between the analgesic effects of
           bilateral erector spinae plane block, and bilateral transversus abdominis plane block in
           patients after abdominal hysterectomy under general anesthesia.
    

Detailed description: 
      Sample size: Assuming that Mean±SD of reduced pain scores in erector spinae plane block is
      4.7±3.7 versus 2.5±1 in transversus abdominis plane block.So, the total sample size is 48
      cases (24 in each group) using Open Source Statistics for Public Health (open Epi) with
      confidence interval 95% and power of test is 80%.

      d) Method of sample collection:

      Forty eight female patients will be divided into two groups by a computer-generated
      randomization table:

      Group (ES) (n=24): will receive bilateral ultrasound guided erector spinae plane block with
      each block 20 ml of bupivacaine 0.375% plus 5ug/ml adrenaline (1:200000) at the level of T9.

      Group (TA) (n=24): will receive bilateral ultrasound guided transversus abdominis plane block
      with each block 20 ml of bupivacaine 0.375% plus 5ug/ml adrenaline (1:200000).
    

Intervention name(s): 1) Ultrasound guided Erector spinae block; Ultrasound guided transversus abdominis plane block
Intervention type(s): Procedure; Procedure
Intervention description(s): In the lateral position, after skin sterilization, erector spinae plane block will be performed at the level of T9. Counting down from the spine of seventh cervical vertebrae, the spine of the nine thoracic vertebrae (T9). A linear low frequency ultrasound transducer (US) (3-5 MHz) will placed sagittal 3cm lateral to midline to visualize the muscles of the back, transverse process and simmering pleura in between transverse processes. A 22-gauge short bevel needle will be inserted in cranial-caudal direction towards transverse process (TP) in plane to the US transducer until needle touched the TP crossing all the muscles. The location of the needle tip will be confirmed by visible normal saline fluid separating erector spinae muscle off the bony shadow of the transverse process on ultrasound imaging. Then 20 ml of bupivacaine 0.375% plus plus 5ug/ml adrenaline (1:200000) will be injected. The procedure will be repeated following the same steps on the other side of the back.; in supine position and after skin sterilization. The linear high frequency transducer (6-13 MHz) will be placed in the transverse plane to the the lateral abdominal wall in the midaxillary line, between the lower costal margin and iliac crest. The three abdominal wall muscles (external oblique, internal oblique, and transversus abdominis) are visualized. The needle inserted in plane and advanced anterior to posterior under continual visualization until the tip between the internal oblique and the transversus abdominis muscle. After negative aspiration, a 20 ml of bupivacaine 0.375% plus 5ug/ml adrenaline (1:200000) will be injected. The success of the injection will be confirmed by separation of the internal oblique and transversus abdominis with a distinct pocket of local anesthetic in between. The procedure will be repeated following the same steps on the other side.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment