Role of Dexamethasone for Erector Spinae Plane Block in Patients Undergoing Total Abdominal Hysterectomy

Aswan University Hospital

Status: Completed

Conditions: Postoperative Pain

Treatments: Drug: dexamethasone; Drug: placebo to dexamethasone; Drug: placebo to bupivacaine; Drug: bupivacaine

Study type: Interventional

Funder types: Other

Identifiers

NCT03769818

aswu/181/18

Details and patient eligibility

About

The aim to study the efficacy of bupivacaine 0.25% with dexamethasone and that of bupivacaine 0.25% alone for erector spinae plane block for postoperative analgesia in patients undergoing total abdominal hysterectomy Group 1: bupivacaine 0.25% + dexamethasone 8 mg

• Group 2: bupivacaine 0.25%
• Group3: control group A prospective Randomized Interventional double-blind study.

Full description

Optimal dynamic analgesia is recognized as the key to enhanced recovery following open abdominal surgery. In the last decade, there has been a significant shift away from thoracic epidural analgesia (TEA) that has been long considered as the gold standard. Various techniques have tried to replicate the analgesic efficacy of TEA. They include transversus abdominis plane analgesia (TAP), rectus sheath analgesia (RS), wound infusion analgesia (WI) and trans muscular quadratus lumborum analgesia. However, each of these techniques has specific limitations that prevent them from being the analgesic technique of choice for all open abdominal surgeries. Chin et al first described the erector spinae plane (ESP) block for providing analgesia following ventral hernia repair. The unique feature of the ultrasound-guided truncal blocks is that in all of these techniques, in contrast to peripheral nerve blocks, no nerve or plexus needs to be identified: Local anesthesia (LA) is injected in a particular muscle plane, in which the injectate spreads and reaches the intended nerves. This simple mechanism has made delivery of nerve blocks easy and versatile.

Enrollment: 150 patients

Sex: Female

Ages: 30 to 60 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Women ranging age between 30-60 years a who undergoing elective total abdominal hysterectomy

Exclusion criteria

• Participants had known sensitivity to bupivacaine
• Participants had difficulty in intubation
• Participants were on chronic pain medication or already on long-term opioids
• Participants smokers
• Participants with disabilities who were unable to communicate pain levels
• refuse to consent

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

---

150 participants in 3 patient groups, including a placebo group

bupivacaine and dexamethasone

Active Comparator group

Description:

Bilateral ESP block with 20 ml of 0.25% bupivacaine + 4 mg/kg dexamethasone diluted with isotonic saline.

Treatment:

Drug: bupivacaine

Drug: dexamethasone

bupivacaine and placebo to dexamethasone

Active Comparator group

Description:

Bilateral ESP block with 20 ml of 0.25% bupivacaine bilaterally plus placebo to dexamethasone

Treatment:

Drug: placebo to dexamethasone

Drug: bupivacaine

control group

Placebo Comparator group

Description:

Bilateral ESP block with placebo to bupivacaine bilaterally plus placebo to dexamethasone

Treatment:

Drug: placebo to dexamethasone

Drug: placebo to bupivacaine