| Control Group |
suprainguinal fascia iliaca plane block |
40 ml bupivacaine 0.25 in each site of injection |
single injection for 10 - 15 mins at end of surgery |
After surgery regarding suprainguinal fascia iliaca block:
The approach to the suprainguinal fascia iliaca block will be very similar to that described by Hebbard in 2011. The patient is positioned supine with extended hip, The anterior superior iliac spine (ASIS) is palpated, the ultrasound probe is placed slightly inferior and medial to it. typical probe positioning over the inguinal ligament with an angle more perpendicular to the inguinal ligament is often preferable. A high-frequency linear ultrasound probe is typically sufficient, although a lower frequency curved probe may be desirable for obese patients. (Hebbard et al., 2011)
Using Desmet technique an echogenic B-bevel needle is inserted with an in-plane technique from the inferior aspect of the probe just superior to the ligament with a significantly steeper angle, which enhances the tactile loss of resistance that is typically felt upon traversing the fascia iliaca and entering the iliacus muscle below (Desmet et al., 2017). After the “pop” through fascia iliaca, the needle may need to be withdrawn slightly to rest at the superficial border of the iliacus. Then, 1-2 ml of saline
or local anesthetic is injected to confirm spread between the hyperechoic fascia iliaca and the more heterogeneous iliacus muscle beneath it. With appropriate spread, the needle is further advanced into the pocket of local anesthetic, moving in the cephalad direction as the iliacus muscle is hydro dissected away from the overlying fascia iliaca.
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28 |
Active-Treatment of Control Group |
| Experimental Group |
Erector spinae plane block |
40 ml of bupivacaine 0.25 at each site of injection |
single shot for 10-15 mins at end of surgery |
Regarding the Erector spinae plane block:
The approach will be very similar to that described by Tulgar S, Senturk O 2017. the patient will be placed in the lateral position. A high-frequency linear probe or a curved probe, depending on the BMI of the patient, will be placed in longitudinal alignment, 2–3cm lateral to the vertebral column. The transverse processes of the vertebrae at the level of L4, the erector spinae muscle, and the psoas muscle will be
identified. An echogenic B-bevel needle will be inserted with an in-plane technique in a cephalad-to-caudal direction until bone contact with the top of the transverse process is reached. After slight retraction of the needle, local anesthetic will be injected behind the erector spinae muscle. (Tulgar and Senturk.2017)
Before proceeding with the nerve block, and after sterilization, skin infiltration with local anesthetic (1 ml of 2% lidocaine) will be done. The needle used for the block will be an echogenic needle of 22 Gauge and 4 inches.
In both groups, A volume of 40 mL of (0.25% bupivacaine) taking into consideration not to exceed the toxic dose for every patient (2.5mg/kg) will be administered after negative aspiration to avoid accidental intravascular injection, and spread of drug solution will be observed in tissue planes under ultrasound imaging
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28 |
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