| Control Group |
general anesthesia |
fentanyl 1 µg/kg then propofol 1- 2 mg/kg, followed by atracurium 0.5 mg/kg for tracheal intubation, and maintained with continuous infusion of fentanyl and propofol guided by bispectral index (BIS) between 40 and 60 |
during surgery |
After induction suitable size double lumen endotracheal tube will be inserted , patient will be placed in a lateral decubitus position. patient will be mechanically ventilated with an oxygen–air mixture to maintain end‑tidal CO2 between 35 and 40 mmHg monitored by capnogram . Routine intraoperative analgesia will be supplementd in the form of acetaminophen 15mg/kg and ketorolac . At the end of surgery neuromuscular blockade will be reversed using intravenout neostigmine (0.05 mg/kg) and atropine (0.01 mg/kg). Extubation will be done and the patients will be transferred to PACU. for fellow up |
30 |
Placebo |
| Experimental Group |
erector spinae plane block and opioid free anesthesia |
at first erector spinae block performed with 20 mL dose of 0.25% bupivacaine
for general anethesia a loading dose of dexmedetomidine 1µg/kg over 10 min, anesthesia will be induced with propofol 1- 2 mg/kg, followed by atracurium 0.5 mg/kg, and will be maintained with continuous infusion of propofol 50 − 200 µg/kg/min and dexmedetomidine 0.3 _0.5 µg/kg/h for maintaining BIS between 40 − 60. Ketamine infusion 0.1- 0.3 mg/kg /hour will be started before incision.(10) Lignocaine 1.5 mg/kg will be administered at induction and an infusion of 2 mg/kg/h will be started immediately after the loading dose |
the block will be performed before induction of anesthesia, , opioid free drugs with induction and during surgery |
Ultrasound guided ESPB will be administered before induction of general anesthesia , paients will receive the block in the sitting position under aseptic conditions at the T5 vertebral level using Philip cx 50 extreme edition , USA. 12 MHz linear US probe will be covered with a sterile sheath and will be placed longitudinally 2 to 3 cm lateral to the T5 transverse process. After visualizing erector spinae muscles superficial to the hyperechoic transverse process shadow a 22-gauge 50-mm block needle (B.Braun Medical Inc.,Bethlehem, PA ) will be inserted in a cephalad to caudad direction Once the needle tip placed within the interfacial plane below the erector spinae muscle, 2 mL of saline will be injected to confirm the proper injection site; then, a 20 mL dose of 0.25% bupivacaine will be injected then after induction of general anesthesia suitable size double lumen endotracheal tube will be inserted , patient will be placed in a lateral decubitus position. patient will be mechanically ventilated with an oxygen–air mixture to maintain end‑tidal CO2 between 35 and 40 mmHg monitored by capnogram . At the end of surgery neuromuscular blockade will be reversed using intravenous neostigmine (0.05 mg/kg) and atropine (0.01 mg/kg). Extubation will be done. |
30 |
|