Modified Versus Conventional Serratus Anterior Plane Block

Study Overview
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Brief Summary
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comparing preemptive analgesia with ultrasound guided modified serratus anterior plane block versus ultrasound guided serratus anterior plane block

Detailed Description
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comparing the quality of postoperative analgesia and opioid consumption in patients undergoing Video-Assisted Thoracoscopic Surgery when using preemptive analgesia with ultrasound guided modified serratus anterior plane block versus ultrasound guided serratus anterior plane block

Official Title
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Ultrasound Guided Modified Versus Conventional Serratus Anterior Plane Block as a Preemptive Analgesia for Unilateral Video-Assisted Thoracoscopic Surgery

Conditions
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Postoperative Pain, Acute

Intervention / Treatment
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* Drug: 25 ml of bupivacaine 0.25% via serratus anterior block
* Drug: 25 ml of bupivacaine 0.25% via modified serratus anterior palne block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient consent. both sex. Age: 21-70 years old. BMI: 18- 30 kg/m2 ASA: I and II. Scheduled for elective unilateral Video-Assisted thoracoscopy under general anesthesia. Exclusion Criteria: History of allergy to the local anesthesia agents used in this study, Skin lesion at needle insertion site, Those receiving anticoagulant therapy or having bleeding disorders Patients with history of chronic pain and taking analgesics, Patients with sepsis and Significant cardiac, liver or renal diseases Uncooperative patients or with psychiatric disorders.

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 |
| --- | --- |
| No Intervention: Control group<br>will take general anesthesia without nerve block | |
| Active Comparator: SAP block group<br>After sterilization of the skin and draping, the high frequency linear probe of Sonosite M Turbo ultrasonography (FUJIFIM sonosite, Inc., Bothell, WA, USA) will be placed at the level of the midclavicular line in a sagittal plane. The second rib will be recognized at the axillary artery. The probe will be moved downward to count the ribs until the level of the ﬁfth rib in the mid-axillary line. At this time, the latissimus dorsi muscle (lying superficial) and the serratus anterior muscle (lying deep) will be clearly visualized under ultrasound . Next, A 22-gauge, 80 mm needle (Stimuplex D, B-Braun, Germany) will be inserted in plane relative to the ultrasound probe between the latissimus dorsi and the serratus anterior muscle. After confirming negative aspiration of blood, 1 ml normal saline will be injected for hydro-dissection sign to verify the needle tip, then a volume of 25 ml 0.25% bupivacaine will be injected superficially to serratus anterior muscle. . | Drug: 25 ml of bupivacaine 0.25% via serratus anterior block<br>* patients will receive conventional serratus anterior plane block with a volume of 25 ml of bupivacaine 0.25% followed by induction of general anesthesia,<br>|
| Active Comparator: modified SAP block group<br>The patient will be placed in the lateral decubitus position according to the selected site of surgical intervention. After sterilization of the skin and draping, the high frequency linear probe of Sonosite M Turbo ultrasonography ( FUJIFIM sonosite, Inc., Bothell, WA, USA) will be placed horizontally midway between tip of the scapula and posterior axillary line to identify the view of latissimus dorsi(lying superficial) and serratus anterior muscle(lying deep) over either the sixth or seventh rib. A 22-gauge, 80 mm needle (Stimuplex D, B-Braun, Germany) will be inserted in plane relative to the ultrasound probe from posteromedial to anterolateral direction toward posterior axillary line till reaching the interfacial plane between latissimus dorsi and serratus anterior muscle . After confirming negative aspiration of blood, 1 ml normal saline will be injected for hydro-dissection sign to verify the needle tip, then a volume of 25 ml 0.25% bupivacaine will be injected . | Drug: 25 ml of bupivacaine 0.25% via modified serratus anterior palne block<br>* patients will receive modified serratus anterior plane block with a volume of 25 ml of bupivacaine 0.25% followed by induction of 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 | at 24 hours postoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time of performance | Time of performance of block defined as time from ultrasound probe positioning till the end of the block procedure | from ultrasound probe positioning till the end of the block procedure | 
| Time to first dose of rescue analgesia | Time to first dose of rescue analgesia (VAS > 3) after surgery | during the first postoperative 24 hours | 
| Patient satisfaction | Patient satisfaction with analgesia in the first 24hours postoperative hours will be Likert scale where 5 is very satisfied and 0 is very dissatisfied. | at 24 hous post operative |