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Confirmation of Thoracic Epidural Space by the presence of waveform and the depth analysis by ultrasound

ABSTRACT: Primary outcome(s): Documentation of epidural waveform through epidural needle and catheter. Timepoint: Immediately after loss of resistance

DISEASE(S): Liver Disease, Unspecified,Malignant Neoplasm Of Rectum,Pseudocyst Of Pancreas,Calculus Of Gallbladder With Acutecholecystitis,C7a8- Other Malignant Neuroendocrine Tumors,Disease Of Intestine, Unspecified,Other And Unspecified Intestinal Obstruction,Other Diseases Of Digestive System,Generalized (acute) Peritonitis,Calculus Of Kidney,Adult Male And Female Patients Of Asa I Or Ii With Body Weight Between 45-70 Kg And Height Of 150-180 Cm, Scheduled For Upper Abdominal Surgeries And Thoracic Surgeries,Acute Cholecystitis,Benign Neoplasm Of Testis,Malignant Neoplasm Of Ill-definedsites Within The Digestive System

PROVIDER: 2581401 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Intervention1: Continuous Bilateral Quadratus Lumborum Block: Patients in CQL (II) group will undergo ultrasound-guided QL (II) block as described by Quiang Zhu et al. The patient should be placed in the left lateral position and a roll to be placed in between the rib cage and transverse process of the left side to open up the opposite space. (22) Then a low frequency convex probe (SonoSite edge transducer, 25 MHz) will be placed at the L2 transverse level near posterior axillary line of the right side to locate the sham-rock sign. The thoracolumbar fascia between the quadratus lumborum and psoas major is identified by optimising the gain. A 19G nerve block needle will be used (PlexoLong Nanoline continuous nerve block Kit, PAJUNK Inc.) to insert by in-plane method from the dorsal to ventral direction. After reaching the front edge of the quadratus lumborum, hydrodissection with 5 ml of normal saline will be done to separate the muscle and the fascia which will indicate that the needle tip has reached the appropriate position. Ropivacaine 0.2% at 0.3 mlÂ·kg 1 will be injected after negative aspiration and then, a 20 G catheter will be placed through the sheath tube at a depth of approximately 5 cm. A subcutaneous tunnel of 3 cm will be made to prevent catheter dislodgment. The same procedure will be followed in the right side. Control Intervention1: Continuous Epidural Block: Patients in the EPI group will undergo epidural placement (in between T9 and T11 level in patients undergoing left-sided hemicolectomy and anorectal surgery and between T8 and T10 in patients undergoing right-sided hemicolectomy) as per the institutional protocol. Patients with block height above T7 level 30 min after completion of the block (in both groups) will be included in the stu Primary outcome(s): 1.To compare NRS scores (at rest) between the continuous quadratus lumborum (CQLâ?¡) and Epidural (Ep) groups at 24 hours after surgery.Timepoint: 1.To compare NRS scores (at rest) between the continuous quadratus lumborum (CQLâ?¡) and Epidural (Ep) groups at 24 hours after surgery. Study Design: Randomized, Parallel Group Trial Method of generating randomization sequence:Computer generated randomization Method of allocation concealment:On-site computer system Blinding and masking:Outcome Assessor Blinded

Project description:BackgroundRecently, robot-assisted thoracic surgery has been increasingly performed for mediastinal disease. However, appropriate postoperative analgesic methods have not been evaluated.MethodsWe retrospectively studied patients who underwent robot-assisted thoracic surgery for mediastinal disease at a single university hospital between January 2019 and December 2021. Patients were performed either general anesthesia alone, general anesthesia combined with thoracic epidural anesthesia, or general anesthesia combined with ultrasound-guided thoracic block. Patients were divided into three groups [non-block (NB), thoracic epidural analgesia (TEA), and thoracic paraspinal block (TB)] according to postoperative analgesic methods, and they compared with terms of postoperative pain scores by using numerical rating scale (NRS) at 0, 3, 6, 12, 18, 24, and 48 h. Additionally, rescue supplemental analgesic within 24 h, side effects of anesthesia such as respiratory depression, hypotension, postoperative nausea and vomiting, pruritus and urinary retention, time to ambulation after surgery, and hospital stay after surgery were also compared among the three groups.ResultsData from 169 patients (Group NB: 25, Group TEA: 102, and Group TB: 42) were progressed to the analysis. Postoperative pain scale at 6 and 12 h was significantly lower in Group TEA than NB (1.2±1.6 vs. 2.4±1.8, P<0.01; and 1.2±1.5 vs. 2.2±1.7, P=0.018, respectively). There were no differences in pain scores between Groups TB and TEA at any point. The incidence of patients using rescue analgesics within 24 h was significantly different between groups [Group NB: 15/25 (60%), Group TEA: 30/102 (29.4%), Group TB: 25/42 (59.5%), P=0.01]. For postoperative side effects, only the number of patients complaining of postoperative nausea and vomiting for 24 h after surgery differed significantly between groups [Group NB: 7/25 (28%), Group TEA: 19/102 (18.6%), Group TB: 1/42 (2.4%), P=0.01].ConclusionsTEA provided better analgesia after robot-assisted thoracic surgery for mediastinal disease than NB as indicated by lower pain scores and fewer rescue analgesic requirements. However, the frequency of postoperative nausea and vomiting was lowest in Group TB of all the groups. Thus, TBs might also provide adequate postoperative analgesia following robot-assisted thoracic surgery for mediastinal disease.

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Confirmation of Thoracic Epidural Space by the presence of waveform and the depth analysis by ultrasound

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