Triamcinolone Versus Methylprednisolone in Transversus Abdominis Plane Block

Study Overview
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Brief Summary
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In the current Study we will compare between triamcinolone and methylprednisolone as an additive to bupivacaine drug in ultrasound guided TAP block in major open abdominal surgery .

Detailed Description
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Postoperative pain is one of the main causes of respiratory function derangement after abdominal surgery .Transversus abdominis plane (TAP) block is widely used in abdominal surgery for postoperative analgesia The transversus abdominis plane (TAP) block is aperipheral nerve block that involves the injection of alocal anesthetic (LA) in the plane between the internaloblique and transversus abdominis muscle layers, with the aim of anesthetizing the intercostal nerves supplyingthe abdominal wall (from T6 to L1) By blocking intercostal nerves T6 to L1, TAPblock efficiently blocks somatic pain after abdominalwall surgery . It providesadequate postoperative pain relief following various abdominal surgeries TAP block can reduce pain scores, opioid consumption, and the incidence of opioid-related complications after abdominal surgery. The duration of the TAP block is limited to theeffect of the administered LAs. Various adjuvantmedications have been added to the LA to prolong theduration of TAP block and magnify its effects . Perineural injection of steroids is reported to influence postoperative analgesia. As a synthetic glucocorticoid, triamcinolone acetonide binds to and activates the glucocorticoid receptor to produce anti-inflammatory responses,such as down-regulating pro-inflammatory cytokine expression , preventing prostaglandin and leukotriene synthesis and release of arachidonic acid, and activating anti-inflammatory transcription factors such as lipocortins

Official Title
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Triamcinolone Versus Methylprednisolone in Ultrasound Guided Transversus Abdominis Plane Block in Major Open Abdominal Surgery

Conditions
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Major Abdominal Surgery

Intervention / Treatment
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* Drug: Triamcinolone
* Drug: Methylprednisolone
* Drug: bupivacaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients scheduled for major open abdominal surgery American Society Anesthesiologists (ASA) physical status I to II Exclusion Criteria: Patient refusal. Morbidly obese patients. Patients with uncontrolled diabetes. Severe or uncontrolled renal, hepatic or endocrinal diseases. Pregnancy, post-partum or lactating females Allergy to one of the agents used. Recent (less than six months) use of glucocorticoids for at least two weeks

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Patient will be evaluated pre operative and full lab will be done In the Pre Anaesthesia Room ,a 20 gauge venous catheter will be inserted in the upper limb , and monitoring included heart rate, electrocardiogram, noninvasiveblood pressure, and peripheral oxygen saturation.Oxygen at the rate of 6 L/min will beadministered through oxygen mask to all patients. The anesthesiologist who performed the block will be blinded to drug solution and not involved in data collection, another anesthesiologist will prepare drug solution and other anesthesiologist collect the data.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: bupivacaine group<br>28 Patients will receive 18 ml of bupivacaine 0.5 % plus 1ml 0.9% saline in TAP block divided equally on both sides | Drug: bupivacaine<br>* transversus abdominis plane block with bupivacaine alone<br>|
| Active Comparator: triamicinolone group<br>28 Patient will receive 18 ml of bupivacaine 0.5 % plus (20 mg of triamcinolone in 1ml 0.9% saline divided equally on both sides in TAP block | Drug: Triamcinolone<br>* transversus abdominis plane block with bupivacain and triamicinolone<br>Drug: bupivacaine<br>* transversus abdominis plane block with bupivacaine alone<br>|
| Active Comparator: methylprednisolone group<br>28 Patient will receive 18 ml of bupivacaine 0.5 % plus (40 mg of methylprednisolone in 1ml 0.9% saline ) on both sides in TAP block. | Drug: Methylprednisolone<br>* transversus abdominis plane block with bupivacaine and methylprednisolone<br>Drug: bupivacaine<br>* transversus abdominis plane block with bupivacaine alone<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| analgesic effect of Triamcinolone and Methylprednisolone In Ultrasound Guided Transversus Abdominis Plane Block ( Tap Block ). | visual analogue scale for assessement of pain from 0 to 10 is used where 0 is no pain and 10 is maximum pain | 24 hours after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| occurance of complication | nausea vomiting hemodynamic changes | 24 hours after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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triamicinolone, methylprednisolone, transversus abdominisus plane block