Erector Spinae Block Versus Transversus Abdominis Plane Block In Laparoscopic Bariatric Surgery

Study Overview
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Brief Summary
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The purpose of this study to compare erector spinae block to transversus abdominis plane block in bariatric surgeries regarding analgesic efficacy and postoperative oxygenation and respiratory complications

Detailed Description
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The erector spinae plane (ESP) block is an interfascial block proposed to provide analgesia for chronic pain and perioperative period. it can provide both visceral and somatic abdominal analgesia if the injection were performed at a lower thoracic level. ESP block is effective, easy to perform, and can be performed in a short time. Therefore, bilateral ESP block may have comparable or improved analgesic effect in upper and lower abdominal surgical procedures when compared to other suitable plane blocks. Transversus abdominis plane (TAP) block technique is to reduce postoperative pain and is a part of current analgesic regimen for many abdominal surgeries . Moreover, it was found that posterior TAP block appears to produce more prolonged analgesia than the lateral TAP block. Ultrasound guided TAP block is a feasible, minimally invasive technique . It reduces the postoperative requirement of opioid analgesics, decreases the incidence and severity of postoperative nausea and vomiting, improves patient satisfaction, and allows early readiness for discharge postoperatively. Both blocks is effective in reducing postoperative complication and need of analgesia , To our knowledge there is no comparative study between the two blocks to this population . the investigators aim to compare the perioperative analgesic effect between TAP block and ES block in bariatric .

Official Title
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The Feasibility and Efficacy of Erector Spinae Block Versus Transversus Abdominis Plane Block In Laparoscopic Bariatric Surgery

Conditions
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Erector Spinae Block, Bariatric Surgery Candidate

Intervention / Treatment
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* Procedure: transversus abdominis block
* Procedure: Erector spinae block
* Drug: Bupivacaine 0.25% Injectable Solution
* Device: Siemens Acuson x300 3-5MHz Ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient age >18 <60 Obese patients ; Body mass index(BMI) 40-50 kg/m2 Both sexes American Society of Anesthesiologists(ASA) physical status classes II and III Patients scheduled for laparoscopic bariatric surgery i.e. sleeve gastrectomy and/or Roux-en-Y gastric bypass (RYGB)surgeries Exclusion Criteria: Refusal of regional block Patients with neurological, psychological disorders or those lacking cooperation Patients scheduled for concomitant laparoscopic cholecystectomy or paraumbilical hernia repair or those with history of previous bariatric surgery or obstructive sleep apnea Patients with anatomic abnormalities at site of injection, skin lesions or wounds at site of proposed needle insertion. Patients with bleeding disorders defined as (INR >2) and/ or (platelet count <100,000/µL) Patients with hepatic disease e.g. liver cell failure or hepatic malignancy or hepatic enlargement. Patients who are allergic to amide local anesthetics. Cases converted to open surgery will also be excluded from the study

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: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: TAP block group<br>the TAP block will be given by a high frequency linear ultrasound transducer of Siemens acuson x300 3-5MHz ultrasound . a blunted tip , 20-gauge, short bevel needle (Pajunk Sonoplex, Geisingen, Germany) will be used under direct ultrasound visualization, . After confirming the correct placement of the needle and the negative aspiration probe anaesthetic substance will be injected along the subcostal line in the transversus abdominis plane 20 ml 0.25% bupivacaine(10) , and the dissection of the plane was observed. The block will be performed bilaterally. | Procedure: transversus abdominis block<br>* transversus abdominis block<br>Drug: Bupivacaine 0.25% Injectable Solution<br>* Local Anesthetic used in both blocks<br>Device: Siemens Acuson x300 3-5MHz Ultrasound<br>* Ultrasound used to aid in the blocks<br>|
| Experimental: ESP group<br>the Erector Spinae block will be given by a high-frequency linear ultrasound transducer of Siemens acuson x300 3-5MHz ultrasound .A blunted tip , 20-gauge, short bevel needle (Pajunk Sonoplex, Geisingen, Germany) will be used under strict aseptic precautions until the tip is deep to erector spinae muscle, The block will be performed bilaterally by injecting 40 mL of 0.25% bupivacaine (20 mL into each side) into the fascial plane between the deep surface of the Erector Spinae muscle and the transverse processes of the lumbar vertebrae laterally | Procedure: Erector spinae block<br>* Erector spinae block<br>Drug: Bupivacaine 0.25% Injectable Solution<br>* Local Anesthetic used in both blocks<br>Device: Siemens Acuson x300 3-5MHz Ultrasound<br>* Ultrasound used to aid in the blocks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| efficacy of block | The analgesic efficacy of erector spinae block versus TAP block assessed by visual analogue score(range from 1 denoted the least pain to 10 as the worst pain) in 24hr in laparoscopic bariatric surgery. | first 24 hours postoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| failure rate | Failure rate in both groups | first hour postoperatively |