Efficacy Of Ultrasound Guided External Oblique Intercostal Plane Block for Subcostal Nephrectomy

Study Overview
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Brief Summary
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The patients will be randomly allocated into two equal groups using a computer program. Group A: will receive external oblique intercostal block after induction. Group B: will receive postoperative morphine per patient request.

Detailed Description
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General anaesthesia induction will be achieved using fentanyl 1µg/kg (IV), propofol 2mg/kg (IV), and0.5mg/kg of IV Atracurium. General anaesthesia will be maintained with mechanical ventilation with isoflurane with O2 \ Air mixture. During anaesthesia maintenance Intraoperatively, if BP or heart rate (HR) increase more than 20% from baseline, intravenous morphine will be given to stabilize the patients' haemodynamics. All patients will receive 1g intravenous paracetamol and 4mg ondansetron 8mg dexamethasone.

Official Title
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Efficacy Of Ultrasound Guided External Oblique Intercostal Plane Block for Postoperative Analgesia in Patients Undergoing Subcostal Nephrectomy: A Randomised Trial

Conditions
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Postoperative Pain

Intervention / Treatment
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* Procedure: external oblique intercostal block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - Eligible patients will be older than 18 years old with American society of anestheologist ASA physical status I, II and III scheduled for Trans-Abdominal ( Anterior Subcostal) Nephrectomy Exclusion Criteria: Patients who are: Unable to cooperate. Patients who have allergy to any of the study drugs. Patients who are on opioids. Known abuse of alcohol or medication. Local infection at the site of injection or systemic infection. Pregnancy Patients with coagulation disorders or on anticoagulation therapy

Ages Eligible for Study
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Minimum Age: 18 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: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: external oblique intercostal block after induction<br>After induction of general anesthesia, external oblique intercostal blocks will be performed with patients positioned in the supine position with their ipsilateral arm abducted. Initially the probe is placed in a cephalad to caudad paramedian direction at the anterior axillary line, and the external oblique muscle identified at the level ribs 6 and 7 in line with the xiphoid process. To confirm correct identification of the external oblique muscle, With 17gauge echogenic ultrasound needle will be advanced in plane from a superomedial-to-inferolateral direction, through the external oblique muscle.30 ml of bupivacaine 0.25% will be administered incrementally. | Procedure: external oblique intercostal block<br>* 20 ml of bupivacaine 0.25% will be administered by US into external oblique intercostal plane at the level of sixth rib space .<br>|
| No Intervention: postoperative morphine per patient request<br>In this group no block will be done only morphine will be given intraoperatively- according to hemodynamic change and postoperative by morphine per patient request | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time for first rescue analgesia | hours | day 0 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| VAS score | 1 to 10 (0 is interpreted as no pain, 1-4 mild pain, 5-6 moderate pain, 7-10 severe pain) | 24 hours | 
| rescue analgesics | morphine mg | 24hous |