Anterior Abdominal Blocks for Postoperative Pain Control in Obese Patients

Study Overview
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Brief Summary
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The purpose of this study is to compare between two surgical techniques for anterior abdominal wall blocks in obese patients Undergoing Major Gynecological Surgery: Surgical Transversus Abdominis Plane [TAP] block versus Rectus Sheath block as regards the efficacy and adverse effects

Official Title
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Anterior Abdominal Blocks for Postoperative Pain Control in Obese Patients Undergoing Major Gynecological Surgery: Surgical Transversus Abdominis Plane Block Versus Surgical Rectus Sheath Block

Conditions
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Postoperative Pain

Intervention / Treatment
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* Procedure: Surgical Transversus Abdominis Plane Block
* Procedure: Surgical Rectus Sheath Block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: female patients undergoing major gynecological surgery with supraumbilical midline incision the first time Body mass index (BMI) more than 40. Exclusion Criteria: patient refusal to participate in the study, reoperation, addiction alcohol abuse hypersensitivity or allergy to the study drugs

Ages Eligible for Study
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Minimum Age: 18 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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Transversus Abdominis Block [TB] group<br>Patients will receive Surgical Transversus Abdominis Plane Block | Procedure: Surgical Transversus Abdominis Plane Block<br>* At the end of operation and after hemostasis, 20 ml of 0.25% bupivacaine will be injected intra-abdominally into the Transversus Abdominis plane at the midpoint of the line connecting the crista iliaca and inferior costal margin and at two locations in the lateral abdominal wall at 3-4 cm inferior to the previous midline injection. The same procedure will be repeated on the opposite side using an identical amount of local anesthetic.<br>|
| Active Comparator: Rectus Sheath Block [RB] group<br>Patients will receive Surgical Rectus Sheath Block | Procedure: Surgical Rectus Sheath Block<br>* At the end of operation and after hemostasis,20 ml 0.25% bupivacaine will be administered slowly under direct vision after careful aspiration to the rectus sheath space which is present inbetween rectus abdominis muscle and the posterior layer of its sheath at the upper pole of the midline incision by time of closure of the anterior abdominal wall. The procedure will be repeated on the opposite side.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total dose of morphine consumption |  | First 24 hours postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numerical rate scale | Postoperative pain will be assessed at rest and coughing using numerical rate scale (NRS) patients are asked to rate their pain on a scale from 0 to 10, where 0 represents no pain and 10 represents the worst pain possible,. | First 24 hours postoperatively | 
| Postoperative respiratory functions | will be measured using incentive spirometer. Patients were asked to do sustained maximal inspiration (SMI) three times. Then average SMI will be recorded. They will be instructed prior to induction of general anesthesia about the usage of incentive spirometer then a basal measurement will be obtained. After recovery, measurement will be obtained on 60 min, 6 hours, 12 hrs and 24 hrs. | First 24 hours postoperatively |