| INTERVENTIONS |
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Intervention type
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Intervention name
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Dose
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Duration
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Intervention description
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Group size
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Nature of control
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| Experimental Group |
injection |
The anaesthesiologist who will be responsible for the patient and records the data will be unaware of patients group allocation .Patients will be randomly allocated into one of three equal groups( 30 patients each ).
The study group
Group I( B-D) (n=30): will receive unilateral USG-deep SAPB 0.4 ml/kg Of 0.25 % isobaric bupivacaine with addition of 0.5 ug/kg dex to be diluted with isotonic saline (30 ml total volume).
Group (B-N) (n=30): will receive unilateral USG-deep SAPB 0.4 ml/kg Of 0.25% isobaric bupivacaine with addition of 10 mg nalbuphine to be diluted with isotonic saline (30 ml total volume).
Group (B- P)( n=30): will receive unilateral USG-deep SAPB 0.4 ml/kg Of 0.25 %isobaric bupivacaine (30 ml total volume).
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The general anesthetic technique will be standardized to all participants in the form of propofol 1.5mgLkg, atracurium 0.5mgLkg and naluphine 10 mg as analgesic then anesthesia maintained by isoflurane one MAC in oxygen 40% .
After that the SAPB will be done to the patient using Ultrasound machine.15 minutes later the surgeon will be allowed to start dissection of the breast tissue. Heart rate (HR) and mean arterial blood pressure (MBP) will be recorded and reported according to the later program scedule.
Post operative assessment
QoR-15 at 24 hour postop-
VAS : 2;4;6;12 and 24 hours-
-Hemodynamic assessment : HR and MAP intraop at 10 min intervals and post op at 2;4;6;12 and 24 hours
-Assessment of post op sedation using Ramsay sedation scale at 2;4 ; 6 and 12 hours post op
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This block will be performed with the patient in the lateral position with block site facing up and the patient's non-dependent arm resting comfortably above their heads, exposing their lateral chest wall at the level of fourth and fifth ribs in the mid-axillary line . We will use Korean Siemens ACUSON X300 ultrasound device in all patients. For right-sided surgery the anaesthetist performing the block should stand on the right side at the head end, with transducer in left hand (for a right sided block), and needle in right hand, while the ultrasound monitor is placed on the other side, so that the operator can have a clear view of both the block area and the screen at the same time. We will start by sterilization of the area of block around the area of mid-axillary by antiseptic solution. We will use a high frequency ultrasound probe (13-16 MHz). Scans will be performed while moving the transducer laterally and distally for counting the ribs from below until the 4th and 5th ribs will be visualized. The transducer will then be rotated into the coronal plane and tilted posteriorly until we get the better view of the relevant anatomical structures, latissimus dorsi muscle LD (lying superficial) and serratus anterior SA (lying deep just above the ribs) thoracodorsal artery and sliding pleura will be identified at the onset of scanning and care will be taken to avoid them. Under complete aseptic technique, the needle (22 gauge spinal needle) will be inserted in plane of the ultrasound beam from posteromedial to anterolateral direction till reaching the fascia between the serratus anterior muscle and the intercostal muscles. After confirming the plane between the two muscles with hydrodissection by saline negative aspiration will be done then the injectate will be given according to the group. Group I( B-D) (n=30): will receive unilateral USG-deep SAPB 0.4 ml/kg Of 0.25 % isobaric bupivacaine with addition of 0.5 ug/kg dex to be diluted with isotonic saline (30 ml total volume).
Group (B-N) (n=30): will receive unilateral USG-deep SAPB 0.4 ml/kg Of 0.25% isobaric bupivacaine with addition of 10 mg nalbuphine to be diluted with isotonic saline (30 ml total volume).
Group (B- P)( n=30): will receive unilateral USG-deep SAPB 0.4 ml/kg Of 0.25 %isobaric bupivacaine (30 ml total volume).
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30 |
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| Experimental Group |
injection |
Group (B-N) (n=30): will receive unilateral USG-deep SAPB 0.4 ml/kg Of 0.25% isobaric bupivacaine with addition of 10 mg nalbuphine to be diluted with isotonic saline (30 ml total volume). |
single injection and follow up for 24 hours |
This block will be performed with the patient in the lateral position with block site facing up and the patient's non-dependent arm resting comfortably above their heads, exposing their lateral chest wall at the level of fourth and fifth ribs in the mid-axillary line . We will use Korean Siemens ACUSON X300 ultrasound device in all patients. For right-sided surgery the anaesthetist performing the block should stand on the right side at the head end, with transducer in left hand (for a right sided block), and needle in right hand, while the ultrasound monitor is placed on the other side, so that the operator can have a clear view of both the block area and the screen at the same time. We will start by sterilization of the area of block around the area of mid-axillary by antiseptic solution. We will use a high frequency ultrasound probe (13-16 MHz). Scans will be performed while moving the transducer laterally and distally for counting the ribs from below until the 4th and 5th ribs will be visualized. The transducer will then be rotated into the coronal plane and tilted posteriorly until we get the better view of the relevant anatomical structures, latissimus dorsi muscle LD (lying superficial) and serratus anterior SA (lying deep just above the ribs) thoracodorsal artery and sliding pleura will be identified at the onset of scanning and care will be taken to avoid them. Under complete aseptic technique, the needle (22 gauge spinal needle) will be inserted in plane of the ultrasound beam from posteromedial to anterolateral direction till reaching the fascia between the serratus anterior muscle and the intercostal muscles. After confirming the plane between the two muscles with hydrodissection by saline negative aspiration will be done then the injectate will be given according to the group. |
30 |
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| Control Group |
injection |
Group (B- P)( n=30): will receive unilateral USG-deep SAPB 0.4 ml/kg Of 0.25 %isobaric bupivacaine (30 ml total volume). |
single injection and follow up for 24 hours |
This block will be performed with the patient in the lateral position with block site facing up and the patient's non-dependent arm resting comfortably above their heads, exposing their lateral chest wall at the level of fourth and fifth ribs in the mid-axillary line . We will use Korean Siemens ACUSON X300 ultrasound device in all patients. For right-sided surgery the anaesthetist performing the block should stand on the right side at the head end, with transducer in left hand (for a right sided block), and needle in right hand, while the ultrasound monitor is placed on the other side, so that the operator can have a clear view of both the block area and the screen at the same time. We will start by sterilization of the area of block around the area of mid-axillary by antiseptic solution. We will use a high frequency ultrasound probe (13-16 MHz). Scans will be performed while moving the transducer laterally and distally for counting the ribs from below until the 4th and 5th ribs will be visualized. The transducer will then be rotated into the coronal plane and tilted posteriorly until we get the better view of the relevant anatomical structures, latissimus dorsi muscle LD (lying superficial) and serratus anterior SA (lying deep just above the ribs) thoracodorsal artery and sliding pleura will be identified at the onset of scanning and care will be taken to avoid them. Under complete aseptic technique, the needle (22 gauge spinal needle) will be inserted in plane of the ultrasound beam from posteromedial to anterolateral direction till reaching the fascia between the serratus anterior muscle and the intercostal muscles. After confirming the plane between the two muscles with hydrodissection by saline negative aspiration will be done then the injectate will be given according to the group. |
30 |
Active-Treatment of Control Group |