Comparison of Thoracic Paravertebral Block , Pectoral Nerve Block to Serratus Anterior Plane Block in Breast Surgery, A Randomized Controlled Study

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• Aortic Dissection 385

Study arms

• Active comparator
  Group I:

  These patients will receive single ipsilateral Ultrasound TPVB which performed with the patient in the sitting position at the level of the T4 with the probe in a vertical position 2.5-3 cm lateral to the midline. The midpoint of the transducer is to be placed in a longitudinal paramedian plane between two transverse processes which visualized with the superior costo-transverse ligament and the pleura visible in between . After this, 15-20 cc of bupivacaine 0.25% will be injected

  Procedure: Thoracic paravertebral block(TPVB) group

• Active comparator
  Group II :

  These patients will receive serratus anterior plane block. The block will be performed while the patient is in the supine position by using a linear Ultrasound probe of high frequency (6-13 MHz) after sheathing. The probe will be placed over the mid-clavicular region of the thoracic cage in a sagittal plane. The ribs will be counted inferiorly and laterally, until the 5th rib is identified in the midaxillary line. The latissimus dorsi (superficial and posterior) , teres major (superior) and serratus muscles (deep and inferior) will be then easily identifiable by U/S overlying the fifth rib.

  Procedure: Thoracic paravertebral block(TPVB) group

Interventions

• ProcedureThoracic paravertebral block(TPVB) group

  Thoracic paravertebral block group (TPVB) group: The midpoint of the transducer is to be placed in a longitudinal paramedian plane between two transverse processes.Tuohy needle will be introduced in a cephalad direction. The tip of the needle will be advanced under direct visualization until it pierces the superior costo-transverse ligament. When the needle tip is located immediately above the pleura, the needle is aspirated to confirm the absence of blood or air. Serratus anterior plane block group (SAP) group: The US probe will be placed over the mid-clavicular region of the thoracic cage in a sagittal plane. The ribs will be counted until the 5th rib is identified in the midaxillary line. The latissimus dorsi, teres major and serratus muscles will be then easily identifiable by US overlying the fifth rib. The needle will be introduced in-plane with respect to the US probe from supero-anterior to postero-inferior

  Also known as: Serratus anterior plane block( SAP) group

Primary outcomes

1. First pain medication request

   Time to the first pain medication request till application of the block

   Time frame: 24 hours

Secondary outcomes

1. Time of pain onset

   Time of onset of Pain

   Time frame: 24 hours

2. Hemodynamics (heart rate)

   Hemodynamics in the form of heart rate "beats per minute"

   Time frame: 24 hours

3. Hemodynamics (ABP)

   Hemodynamics in the form of arterial blood pressure" mm Hg".

   Time frame: 24 hours

4. Nausea and vomiting

   Postoperative nausea and vomiting

   Time frame: 24 hours

Individual participant data

Plan to share: No — Via scholar Gate