Transversus Abdominis Plan Block Versus Rectus Sheath Block

Sisli Hamidiye Etfal Training and Research Hospital

Status: Not yet enrolling

Conditions: Postoperative Complications; Postoperative Pain; Abdominal Obesity

Treatments: Procedure: rectus sheat block; Procedure: transversus abdominis plane block

Study type: Interventional

Funder types: Other

Identifiers

NCT06897345

salkaya-1

Details and patient eligibility

About

The investigator aims to compare the analgesic efficacy of Transversus Abdominis Plan Block and Rectus Sheath Block which are used to prevent intraoperative and postoperative pain and reduce the use of opioid in abdominoplasty operations.

Full description

Abdominoplasty is a frequently performed surgical procedure in aesthetic and plastic surgery. It is performed to solve the pain caused by the large abdomen, respiratory distress and aesthetic problems. Since large tissue excision is made and a large area is worked on, providing perioperative pain control is also important to prevent both postoperative respiratory distress and postoperative chronic pain formation.

In order to prevent both intraoperative and postoperative pain and to reduce opioid use, peripheral nerve blocks that provide analgesia on the abdominal wall can be applied to patients before the surgical incision. The most well-known of these blocks is the Transversus Abdominis Plane block. Another block that has been proven effective in abdominal surgery is the Rectus Sheath block. In the Transversus Abdominis Plane block (TAP), local anesthetic is injected into the fascia between the internal oblique and transversus abdominis muscles, aiming for analgesia. It provides multidermatomal sensory block by spreading the local anesthetic agent in the fascial area. The Rectus Sheath (RK) block is also a preferred plan block in abdominoplasty surgery. In this block, local anesthetic agent is injected between the rectus muscle and the posterior rectus sheath to achieve analgesia.

Although the effectiveness of both blocks has been shown mostly in abdominoplasty operations, there is no publication in the literature showing and comparing their effectiveness in abdominoplasty operations. With this study, The investigator aimed to compare the analgesic effectiveness of the two blocks in patients who will undergo abdominoplasty operations.

Enrollment: 60 estimated patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

Patients who will undergo elective abdominoplasty

• Patients between the ages of 18-65
• ASA (American Society of Anesthesiologists) I-II-III patients
• Patients with a body weight between 50-80 kg

Exclusion criteria

• • ASA IV patient group
• Patients under 18 years of age
• Patients without cooperation
• Patients with chronic alcohol use
• Patients in whom peripheral plane block application is contraindicated (infection at the application site, coagulopathy, local anesthetic allergy)
• Patients who do not want to participate in the study

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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60 participants in 2 patient groups

transversus abdominis plane block

Active Comparator group

Description:

After administering 0.02 mg/kg midazolam for sedation to Group TAP patients, they will be placed in the supine position on both sides under sterile conditions using the high-frequency linear probe of the Esaote CA631 brand ultrasound, and the linear probe will be slid from the bilateral umblicus level to the midaxillary line, and when the internal and external oblique muscles are seen, the needle will be advanced from medial to lateral in an inplane manner, and the fascia between the internal oblique and transversus abdominis muscles will be reached, and after negative aspiration, 20 cc of 0.25% bubivacaine will be injected.

Treatment:

Procedure: transversus abdominis plane block

rectus sheat block

Active Comparator group

Description:

After administering 0.02 mg/kg midazolam for sedation, in the supine position, under sterile conditions, using the high-frequency linear probe of the Esaote CA631 brand ultrasound, 1 cm laterally over the umblicus, and after negative aspiration between the rectus muscle and the posterior rectus sheath, 20 cc of 0.25% bubivacaine will be injected (bilateral). 15 minutes after the block is applied, general anesthesia will be applied to the patients in both groups with 1 mcg/kg fentanyl, 2 mg/kg propofol, 0.6 mg/kg rocuronium intravenously and they will be orotracheal intubated. Intraoperative remifentanil needs will be recorded. Within the scope of multimodal analgesia, 1 g paracetamol will be administered to all patients 30 minutes before the end of the operation and 3 mg/kg sugammadex will be administered at the end of the operation and they will be extubated.

Treatment:

Procedure: rectus sheat block