Rhomboid Intercostal Block Versus Serratus Anterior Plane Block

Study Overview
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Brief Summary
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evaluate and compare the impact of ultrasound guided rhomboid intercostal block versus serratus anterior plane block for analgesia after thoracodorsal artery perforator flap following partial mastectomy

Detailed Description
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To assess and compare quality of post- operative analgesia in each group. Time of performance of block in both groups. To assess and compare post-operative hemodynamics as well as anticipated adverse effects including nausea, vomiting, itching, hemorrhage, bradycardia, hypotension.

Official Title
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Ultrasound Guided Rhomboid Intercostal Block Versus Serratus Anterior Plane Block for Analgesia After Thoracodorsal Artery Perforator Flap Following Partial Mastectomy

Conditions
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Postoperative Pain

Intervention / Treatment
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* Procedure: general anesthesia
* Procedure: general anesthesia plus Rhomboid intercostal block
* Procedure: Serratus anterior plane block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients aged between 21 to 60 years Undergoing pedicled thoracodorsal artery perforator flap following breast conserving surgery -General anesthesia Informed consents ASA I & II Body mass index 25-30 kg/m2. Exclusion Criteria: patients on anti-platelet, anticoagulant or B blocker drugs Patients with acute decompensated heart failure, hypertension, heart block, coronary disease, Asthma, bleeding disorders, compromised renal or hepatic function history of allergy to local anesthesia or opioid analgesia, pregnancy.

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group C:<br>control group who will be given general anesthesia only | Procedure: general anesthesia<br>* general anesthesia<br>|
| Active Comparator: Group R:<br>Rhomboid intercostal block then general anesthesia | Procedure: general anesthesia<br>* general anesthesia<br>Procedure: general anesthesia plus Rhomboid intercostal block<br>* the patients will be positioned in lateral decubitus with moving the scapula laterally by abducting the ipsilateral arm across the chest. under complete aseptic situations A high-frequency (6-12 MHz) linear US probe will be put medial to the medial border of the scapula in an oblique sagittal plane with the orientation marker directed cranially.at the T6-7 level, the tissue plain between the rhomboid major and intercostal muscles is identified, and a single injection of 25mL of bupivacaine (0.25%) will be administered via 18-gauge Tuohy advanced in plane from a superomedial to an inferolateral direction, followed by general anesthesia<br>|
| Active Comparator: group S<br>Serratus anterior plane block then general anesthesia | Procedure: general anesthesia<br>* general anesthesia<br>Procedure: Serratus anterior plane block<br>* The patient will be positioned supine with his arm abducts at 90°. the US high frequency (6-12 MHz) linear probe of sonosite M turbo ultrasonography (FUJIFIM sonosite, Inc., Bothell, WA, USA) will be put in sagittal plane at the midaxillary line. identification of the fascial plane between the serratus anterior muscle and external intercostal muscles will be performed between the fourth and fifth ribs in the midaxillary area . At this point the18-gauge Tuohy needle will be advanced in plane with injection of 25mL of 0.25 %, bupivacaine. followed by general anesthesia<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| tramadol consumption | The amount of tramadol consumption | at 24 hours postoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time of performance of block | Time needed to performance the block | time from positioning of ultrasound porbe till the end of block procedure. | 
| Time to first dose of rescue analgesia | the first time that the patients need analgesia when VAS ≥ 3 | during the first 24 hours postoperatively | 
| Anticipated side effect | nausea, vomiting, local anesthesia toxicity, needle injury | at 24 hous post operative | 
| Post operative patient's satisfaction | Post operative patient's satisfaction using 3 point scale (1= satisfied ,2=neutral, 3=not satisfied) | at 24 hours post operative | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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rhomboid intercostal block -serratus anterior plane block - thoracodorsal artery perforator flap