Ultrasound- Guided Mid Point Transverse Process to Pleura Block

Tanta University

Status: Completed

Conditions: Regional Anesthesia for Postnephrectomy Pain

Treatments: Procedure: Mid transverse process to pleura Sham block; Procedure: Mid transverse process to pleura block (MTP)

Study type: Interventional

Funder types: Other

Identifiers

NCT05806229

POST NEPHRECTOMY PAIN

Details and patient eligibility

About

Radical nephrectomy is the surgical process for the resection of malignant tumors of the kidney necessitating a subcostal flank incision.Mild to severe pain is observed in the postoperative period Ineffective pain management leads to several complications. The mid point transverse process to pleura block (MTP) , this technique was used for pain relief after mastectomy, thoracic, abdominal, and spinal surgery and was found effective due to its simplicity and lower risks compared to epidural analgesia.

Full description

Ineffective pain management leads to several complications including immobilization, thromboembolism, persisting chronic pain, increased opioid consumption, and delayed hospital discharge.[3]

Multimodal analgesic (MMA) regimens using several drugs and techniques are considered to be necessary for postoperative pain relief. Regional anesthesia techniques, mainly epidural analgesia and more recently, paravertebral blocks became crucial parts of a MMA regimen after the introduction of ultrasound (US) in the regional anesthesia practice.

The mid point transverse process to pleura block (MTP) block was first described as a modified paravertebral block in 2017. The local anesthetic drugs are administered between the transverse process and the pleura. This results in a local anesthetic drugs spread to the dorsal and ventral rami in the paravertebral space through the fenestrations in the superior costotranverse ligament (SCTL) at the level of injection, and frequently to adjacent levels.

This technique was used for pain relief after mastectomy, thoracic, abdominal, and spinal surgery and was found effective due to its simplicity and lower risks compared to epidural analgesia.

Enrollment: 70 patients

Sex: All

Ages: 21 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

• Inclusion Criteria: - ASA II and III patients
• scheduled for partial or radical nephrectomy
• standard flank incision either subcostal ,intercostal or supracostal approach
• under general anesthesia.

Exclusion Criteria:

• Bleeding disorders,
• Mental or cognitive dysfunction,
• History of chronic analgesic or drug abuse,
• Allergy to local anesthetics
• Local infection at site of block

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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70 participants in 2 patient groups

Group I

Active Comparator group

Description:

(Mid transverse process to pleura block ) : Patients will receive midpoint transverse process to pleura block with bupivacaine 0.5% (DBK Pharmceutical) (20ml) and dexamethazone 4 mg (SIGMATEC) (1ml) total volume 21 ml

Treatment:

Procedure: Mid transverse process to pleura block (MTP)

Group II

Sham Comparator group

Description:

Patients will receive midpoint transverse process to pleura block with 2ml normal saline subcutaneously (shamblock)

Treatment:

Procedure: Mid transverse process to pleura Sham block