Erector Spinae Plane Block Versus Transversus Abdominis Plane Block in Abdominoplasty Surgery

Study Overview
=================
Brief Summary
-----------------
Abdominoplasty is one of the most popular body-contouring procedures. Patients that undergo body-contouring abdominoplasty usually have important analgesic requirements. Given the substantial incision and soft-tissue undermining associated with this procedure, postoperative pain is a concern for patients and surgeons. Previous studies have typically incorporated multiple nerve blocks to improve analgesia after abdominoplasty. Different anesthetic techniques have been developed to overcome this problem such as Epidural anesthesia, Transversus abdominis plane block either open technique or ultrasound-guided, Paravertebral block and Erector Spinea plane block. Improving postoperative pain control in this kind of surgery leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction. The ultrasound-guided erector spinae plane (ESP) block is a recent block described for various surgeries for postoperative analgesia. It is reported that it have an analgesic effect on somatic and visceral pain by affecting the ventral rami and rami communicantes that include sympathetic nerve fibres, as LA spreads through the paravertebral space. When performed bilaterally it has been reported to be as effective as thoracic epidural analgesia. The transversus abdominis plane (TAP) block is a technique of locoregional anesthesia that blocks the sensorial afferent nerves localized between the transversus abdominis muscle and the internal oblique muscle. In this study, the analgesic efficacy and duration of ultrasound (US) guided Erector spinea plane block and Transversus abdominis plane block when Lidocaine HCL is added as an adjuvant to bupivacaine will be compared.

Detailed Description
-----------------
Sample size was calculated using Power Analysis and Sample Size software program (PASS) version 15.0.5 for windows (2017) using previous results with the mean opioid consumption in the first postoperative day as the primary outcome. Effect size of 0.5 (medium effect size) was calculated using the difference between the mean opioid consumption in TAB group (140 mg) and that in ESPB group (124.6 mg) with an estimated standard deviation of 30 in both groups. This study will add a control group in which only intravenous analgesics will be used; hence the aforementioned effect size was used for sample size calculation using a one-way ANOVA test. Sample sizes of 18 patients in each group are needed to achieve 90% power (1-β) to detect differences among the means using an F test with a 0.05 significance level (α). The size of the variation in the means is represented by the effect size f = σm / σ, which is 0.5. A 20% drop out is expected so the drop-out inflated sample size will be 23 patients in each group.

Official Title
-----------------
Erector Spinae Plane Block: An Analgesic Technique as an Alternative to Transversus Abdominis Plane Block in Abdominoplasty Surgery

Conditions
-----------------
Abdominoplasty

Intervention / Treatment
-----------------
* Procedure: Erector spinea plane block group
* Procedure: Transversus abdominis plane block
* Procedure: Control group


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: American society of anesthesiologist grade I-II Exclusion Criteria: Patient refusal. Local skin infection and sepsis at the site of the block. Allergy to local anesthetic used. Hematological diseases Bleeding disease. Coagulation abnormality. Psychiatric disorders.

Ages Eligible for Study
-----------------
Minimum Age: 25 Years
Maximum Age: 65 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: single-blind study
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Erector spinea plane block group<br>this group is planned for ultrasound-guided Transversus abdominis plane block | Procedure: Erector spinea plane block group<br>* Which will receive ultrasound-guided erector spinea plane block bilaterally and the local anesthetic injected will be total volume 25 ml on each side consisting of 15ml of 0.5% plus 5 ml 2% lidocaine HCL plus 5 ml saline<br>|
| Active Comparator: Transversus abdominis plane block<br>this group is planned for ultrasound-guided Transversus abdominis plane block | Procedure: Transversus abdominis plane block<br>* Which will receive ultrasound-guided Transversus Abdominis plane block bilaterally and the local anesthetic used will be total volume 25 ml on each side consisting of 15ml of 0.5% plus 5 ml 2% lidocaine HCL plus 5 ml saline<br>|
| Placebo Comparator: Control group<br>standard general anesthesia | Procedure: Control group<br>* this group will receive only standard general anesthesia<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total opioid consumption | cumulative consumption of rescue opioids during the first postoperative day | For 24 hours after performing block | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of analgesia | the first time patient requests analgesia postoperatively | for 24 hours after performing block | 
| Postoperative visual analogue score | postoperative visual analogue score (VAS)which will be used to determine the postoperative pain levels in patients. ( 0 representing no pain and 10 is the worst imaginable pain) will be assessed at 2h, 4h,6h,12h,18h and 24h postoperative. Diclofenac75 mg IV and paracetamol 500 mg will be given to all patients in the three groups every 12 hours. If VAS is > 4 patient will receive pethidine 25 mg IV | for 24 hours after performing block | 
| Cortisol level | Cortisol level will be assayed in the serum | For one hour after performing block | 
| Heart rate | Changes in heart rate | For 24 hours after surgery | 
| Mean arterial blood pressure | Changes in mean arterial blood pressure | For 24 hours after surgery | 
| Peripheral oxygen saturation | Changes in peripheral oxygen saturation as measured with pulse oximetry | For 24 hours after surgery | 
| Nausea and vomiting | 0: No nausea, 1: mild nausea, 2: moderate nausea, 3: severe nausea or vomiting | For 24 hour after surgery |