Symptoms and General Pathology

All Conditions

Neoplasms

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Gland and Hormone Related Diseases

Rare Diseases

Pain, Postoperative

Ovarian Neoplasms

Carcinoma, Ovarian Epithelial

Pain

Ovarian Cancer

Ovarian Epithelial Cancer

Central Nervous System Depressants

All Drugs and Chemicals

Anesthetics

Bupivacaine

"ESP block group" ,Patients received preoperative US guided ESP block on BOTH sides to be operated upon 30 minutes before being transferred to the OR

"TAB group" ,Patients received bilateral lower TAB 30 min before being transferred to the OR

"the control group", Patients will not receive any block.

A volume of 20 ml for each side of erector spinae plane with 0.25% plain bupivacaine

erector spinae block

A volume of 20 ml for each side of transversus abdominis plane with 0.25% plain bupivacaine

transversus abdominis block

Postoperative pain is one of the greatest patient concerns following any surgery. Although an increased emphasis has been placed on pain management, approximately 80% of surgical patients report postoperative pain with 86% of patients rating their pain as moderate, severe, or extreme.

In recent years, the increasing adoption of ultrasound-guided regional anesthesia for acute pain management parallels the rapid rise in the availability of ultrasound machines, facilitating description of a number of important fascial plane blocks blocking the dorsal, lateral and anterior cutaneous nerves of the thorax and abdomen. These new descriptions in blocks are supposed to be an advance in regional anesthesia due to its simplicity and lack of complications. These include the transversus abdominis plane block, rectus sheath block, quadratus lumborum block, pectoralis nerve block, serratus plane block, retrolaminar block, and now the Erector spinae block.

Although ESP and TAB blocks successfully reduced postoperative opioid consumption in previous studies, no study has ever compared their efficacy in postoperative analgesia of adult patients undergoing ovarian cancer surgery under general anesthesia thus in this randomized controlled study we are aiming to fill this gap in the literature.

Hypothesis Analgesia provided by the erector spine plane block is superior to that of transversus abdominis block in patients undergoing ovarian cancer surgery under general anesthesia.

Introduction:

Postoperative pain is one of the greatest patient concerns following any surgery. Although an increased emphasis has been placed on pain management, approximately 80% of surgical patients report postoperative pain with 86% of patients rating their pain as moderate, severe, or extreme.

In recent years, the increasing adoption of ultrasound-guided regional anesthesia for acute pain management parallels the rapid rise in the availability of ultrasound machines, facilitating description of a number of important fascial plane blocks blocking the dorsal, lateral and anterior cutaneous nerves of the thorax and abdomen. These new descriptions in blocks are supposed to be an advance in regional anesthesia due to its simplicity and lack of complications. These include the transversus abdominis plane block, rectus sheath block, quadratus lumborum block, pectoralis nerve block, serratus plane block, retrolaminar block, and now the Erector spinae block.

The TAP is a potential anatomical space that lies between transversus abdominis and internal oblique muscles, where local anesthetic can be deposited, creating a non-dermatomal "field block.".This block can be placed before or during a surgery either by ultrasound guidance or by landmarking through the triangle of Petit (inferior lumbar triangle). Blocks can be placed either intra-abdominally prior to abdominal fascial closure or by transdermal injection. Transversus abdominis plane (TAP) blocks can provide reliable relief of somatic incisional pain. However, the lack of reliable visceral pain relief with TAP blocks may necessitate additional modes of analgesia.

Previous studies have investigated the efficacy of TAP blocks in benign gynecology, general surgery,and non-ovarian gynecologic oncology.These studies have had mixed outcomes, but a recent meta-analysis has demonstrated an overall reduction in pain and opioid usage associated with TAP blocks in laparotomy.

Since its first description by Forero et al. there have been many articles and case reports including an increasingly number of indications for the ESP block: chronic and acute pain treatment , rib fractures management in the emergency setting, treatment of abdominal surgical pain , hip arthroplasty , analgesic management in breast surgery,or in spinal surgery.

The ESP block targets the erector spinae plane, which lies between the anterior surface of the cephalon-caudal oriented erector spinae muscles (that arise from and insert into various bony components of the vertebral column, for example, from spinous process to spinous process, rib to rib, and transverse process to transverse process and the posterior surface of the spinal transverse processes. LA is deposited in the fascial plane deep to the erector spinae muscle and superficial to the tips of the transverse processes, from where it diffuses to the dorsal and ventral rami of spinal nerves, achieving an extensive multi-dermatomal sensory block of the posterior, lateral, and anterior thoracic wall .

ESP block could result in both visceral and somatic abdominal analgesia if the injection were performed at a lower thoracic level.as the local anesthetic penetrates anteriorly through the intertransverse connective tissue and enters the thoracic paravertebral space where it can potentially block not only the ventral and dorsal rami of spinal nerves but also the rami communicants that transmit sympathetic fibers.

For 2019 about 22,530 women will receive a new diagnosis of ovarian cancer and about 13,980 women will die from ovarian cancer as for The American Cancer Society estimation for ovarian cancer in the United States. oncologic ovarian cancer surgeries performed by general anesthesia (GA),cannot provide adequate postoperative pain control as cytoreductive and staging procedures often involve considerable visceral disruption and incisions above the umbilicus have accessory innervation. and the routine use of parenteral opioids aggravates postoperative sedation, nausea, emesis, impaired oxygenation and depressed ventilation.

Although ESP and TAB blocks successfully reduced postoperative opioid consumption in previous studies, no study has ever compared their efficacy in postoperative analgesia of adult patients undergoing ovarian cancer surgery under general anesthesia thus in this randomized controlled study we are aiming to fill this gap in the literature.

Aim of the work Aims to evaluate the analgesic effects of combined general with ultrasound-guided erector spinae block versus that of combined general with transversus abdominis block in patients undergoing major ovarian cancer surgery 1. Inclusion criteria female Patients undergoing ovarian cancer surgery under general anesthesia with ASA I-II and Age ≥ 18 and ≤ 65 Years 2. Exclusion criteria

* Patient refusal.
* uncooperative patients
* Cardiovascular disease in the form of Uncontrolled hypertension, IHD, AF, cardiomyopathy with EF \<50%
* Cerebrovascular insufficiency in the form of TIAs, REND, stroke, cerebral hemorrhage, brain tumour, epilepsy
* Coagulation defects with INR\>1.5 platelets count\< 80000
* hepatic insufficiency with ALT and AST \> twice normal, total bilirubin \>1.5 , PC \< 80%.
* Hypersensitivity to the study drugs.
* Pregnant patients
* patients receiving vasoactive drugs or beta blockers V. Study Procedures

  1. Randomization (in RCT only) Computer generated sequence will be used for randomization.
  2. Study Protocol After approval of the Research Ethics Committee and written informed consent from all patients, A randomized, prospective, comparative, single blinded as the anesthesiologist who will collect data will be blinded for which block was given study to compare between ultrasound-guided erector spinae plane block and transversus abdominis plane block for postoperative analgesia of adult patients undergoing ovarian cancer surgery under general anesthesia with lower midline incision approach will be conducted on A total of 45 Patients that will be randomly allocated by using computer generated random numbers into Group1: (n=15) "ESP block group" ,Patients received preoperative US guided ESP block on BOTH sides to be operated upon 30 minutes before being transferred to the OR, Group 2: (n=15) "TAB group" ,Patients received bilateral lower TAB 30 min before being transferred to the OR and Group 3: (n=15)"the control group", Patients will not receive any block.

The day before surgery, all patients will be instructed to fast for 6-8 hours. On the day of the operation, the patient will arrive to the preparation room 1 hour before operation, to allow time for the block procedure and a minimum of 30 minutes to pass after the block before induction of general anesthesia, an 18 G cannula insertion, a start of IV fluid drip, and premedication with 0.02-0.03 mg/kg intravenous midazolam will be done. All basic monitoring will be applied (ECG/HR/SpO2/NIBP), and baseline values for HR, SPO2, SBP, DBP and MAP will be documented then every 5 minutes till the patient reaches the operating room.

In group 1 a mark will be applied on the required level (T10) identified as 3rd spinous process caudal to that of T7 which located in the middle of a line passing between the lower tips of the scapulae, the midline (spinous processes) and the injection points 3 cm on either sides from midline. While the patient is in a sitting position with support from a member of staff, Preparation of the field with iodine will be made. The ultrasound transducer is placed in a longitudinal parasagittal orientation using the HFL38X linear multi-frequency 6-13 MHz probe of SonoSite M-Turbo of portable ultrasound system anatomical landmarks will be identified including the transverse process at T10 level and the layers of muscles from posterior to anterior: trapezius-erector spinae. After subcutaneous lidocaine 2% injection a 22-G spinal needle will be inserted under ultrasound guidance in plane, aiming towards the transverse process. After a Gentle contact with the transverse process, a volume of 20 ml for each side with 0.25% bupivacaine will be injected in increments with careful repetitive aspiration to avoid intravascular injection targeting to cover dermatomal levels from T8-T12 as minimum.

In group 2 while the patient is lying supine, the probe will be placed perpendicular to the mid-axillary line between the iliac crest and subcostal margin, the 3 abdominal muscle layers were identified, and the transversus abdominis plane was located between the internal oblique and transversus abdominis muscle. Next, 20 mL of 0.25% bupivacaine will be injected in increments with careful repetitive aspiration to avoid intravascular injection, and drug spread in the plane will be observed. The same procedure will be repeated on the other side of the abdomen.

Then the patient will be transferred to the OR. All basic monitoring will be applied (ECG/HR/SpO2/NIBP) while monitoring of end-tidal CO2 will be initiated after induction of anesthesia and values will be recorded for HR, SPO2 ,SBP,DBP ,MAP and ETCO2 every 5 minutes till the end of the surgery then for 30 minutes from time of reaching PACU.

General anesthesia will be induced with 2 mg/kg propofol, 1μg/kg fentanyl and 0.5 mg/kg atracurium to facilitate endotracheal intubation. After intubation the lungs will be mechanically ventilated to maintain the ETCO2 35-40 mmHg. Anesthesia will be maintained with isoflurane keeping the ET concentration of isoflurane 1-2% to maintain the BIS value 40-60. Atracurium besylate top-up doses 0.1mg/kg will be given based on the response to train of four ulnar nerve stimulation. Additional fentanyl dose of 0.5 µg/kg IV for maximum of 3 µg/kg will be given if HR and /or BP increased more than 20% from baseline in response to surgical stimulation and the total dose of fentanyl will be recorded.

The patient's pain will be monitored and documented using the Numerical Rating Score (NRS) for pain at times 0,30 minutes, 1, 2, 4, 6, 8, 10, 12, 18 and 24 hours.(28)The "zero" point of time will be the moment the patient recovered from general anesthesia. Time to first analgesic requirement will be recorded which is the time from the "zero" point till the NRS is 4 or more.

1 g paracetamol IV will be given every 6 hours regardless the NRS value while rescue medication in the form of 50 mg tramadol IV will be given on demand when NRS score is 4 or more with maximum dose of 1 mg /kg every 6 hours and the total consumption of tramadol will be recorded.

Complications in the form of local anesthetic systemic toxicity, failed block, injury to surrounding structures (peritoneum, vessels, dura ,pleura inform of pneumothorax) will be documented

Ultrasound-guided Erector Spinae Plane Block Versus Transversus Abdominis Plane Block for Postoperative Analgesia of Adult Patients Undergoing Ovarian Cancer Surgery

A Comparison Between Ultrasound-guided Erector Spinae Plane Block and Transversus Abdominis Plane Block for Postoperative Analgesia of Adult Patients Undergoing Ovarian Cancer Surgery Under General Anesthesia: Randomized, Controlled Study.

Cairo University

Lecturer of anesthesia

Urinary Bladder Neoplasms

Urologic Neoplasms

Urogenital Neoplasms

Urogenital Diseases

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

Urinary Bladder Diseases

Urologic Diseases

Male Urogenital Diseases

Pharmaceutical Solutions

Anesthetics, Local

After skin sterilization, ESP block will be performed at the level of T9. A curvilinear high-frequency ultrasound transducer will be placed sagittal 3 cm lateral to T9 spinous process where a hyperechoic shadow of the transverse process (TP) and erector spinae will be defined. A 22-gauge spinal needle will be inserted in cranial to caudal direction toward TP in plane to the ultrasound transducer until the needle touches the TP crossing the whole muscles. The location of the needle tip will be confirmed by visible normal saline solution separating erector spinae muscle off the bony shadow of the TP on ultrasound imaging. After confirming the needle site, 30 mL of 0.25% bupivacaine will be injected. Sonographic confirmation of the local anesthetic spread will be seen as an anechoic shadow in the paravertebral spaces from T7 to T12.

This procedure will be done on both sides.

Erector Spinae Plane Block

After skin sterilization, curvilinear high-frequency ultrasound transducer will be used to visualize the T10 paravertebral space in the paramedian sagittal plane. An injection into the paravertebral space will spread to multiple adjacent dermatomes, so exact identification of a specific level will be not necessary. A 22-gauge spinal needle will be inserted in-plane relative to the ultrasound probe and slowly be directed from lateral to medial until its tip was located at the apex of the paravertebral space and the endpoint for successful block will be anterior displacement of the pleura by injected local anesthetic where a single injection of 30 ml of 0.25% bupivacaine will be injected.

This procedure will be done on both sides.

Thoracic Paravertebral Plane Block

After skin sterilization, curvilinear high-frequency ultrasound transducer will be positioned horizontally in the anterior axillary line halfway between the subcostal margin and iliac crest, to locate the triple abdominal muscle layers, then the probe will be relocated subsequently to the posterior axillary line until the quadratus lumborum muscle could be visualized with its attachment to the lateral edge of the transverse process of the L4 vertebral body. With the psoas major muscle anteriorly, the erector spinae muscle posteriorly and the quadratus lumborum muscle adherent to the apex of the transverse process, this is a well-recognizable pattern of a shamrock with three leaves. A 22-gauge spinal needle will be inserted in-plane relative to the ultrasound probe passing in posterior to anterior direction through the quadratus lumborum to reach the border between it and psoas major, where 30 ml of 0.25% bupivacaine will be injected.

This procedure will be done on both sides.

Quadratus Lumborum Plane Block

Moustafa M Zalat, MSc

Nazmy S Michael, MD

Radical cystectomy is the gold standard treatment for muscle invasive bladder cancer as well as some T1 and non-invasive disease. It is a major operation with significant perioperative morbidity and complications. Pain is one of the most important complications to be managed.

Regional blocks as a part of multi-modal analgesia are considered main strategies of Enhanced Recovery after Surgery (ERAS) decreasing post-operative complications including post-operative pain and post-operative hospital stay. They also have an upper hand over systemic intravenous opioids decreasing the risk for post-operative delirium specially in old age patients. Thoracic paravertebral plane block (TPVPB), intra muscular quadratus lumborum plane block (QLPB) and erector spinae plane block (ESPB) are among these regional anesthesia techniques for pain management.

Erector spinae plane block is an emerging block, with low risk and more feasibility, but efficacy hasn't been compared to quadratus lumborum and paravertebral plane blocks altogether in radical cystectomy surgeries.

All these blocks are effective in reducing postoperative pain and the need of analgesia in radical cystectomy surgery; this is a comparative study between the three blocks in this population.

3 Ultrasound Guided Plane Blocks for Perioperative Analgesia in Patients Undergoing Radical Cystectomy

Comparative Assessment of 3 Ultrasound Guided Plane Blocks for Perioperative Analgesia in Patients Undergoing Radical Cystectomy: A Randomized Clinical Trial

Total dose of Morphine (measured in mg) given intra-venously to the patient post-operatively.

Nazmy Edward Seif

Clinical Professor

Skin and Connective Tissue Diseases

Breast Neoplasms

Breast Diseases

Skin Diseases

Anesthetics, General

Patients randomised to receive pectoral plane blocks and a sham local anaesthetic infusion wound catheter

Patients randomised to receive a local anaesthetic infusion wound catheter; No sham pectoral plane block performed as patients usually under general anaesthetic at time of block.

Patients randomised to receive pectoral plane blocks and a local anaesthetic infusion wound catheter.

Pectoral Plane Block

Levobupivicaine 0.1% @10ml/hr via a wound infusion catheter

Local Anaesthetic Wound Infusion Catheter

Donal Buggy

In this proposed study, the investigators are looking to conduct a prospective, randomised, double-blind, non-inferiority trial, to study single-shot pectoral plane (PECs) blocks versus continuous local anaesthetic infusion analgesia versus a combination of PECs blocks and local anaesthetic infusion analgesia, when it comes to providing analgesia for most forms of breast surgery.

Breast surgery is common, and the optimal form of analgesia is currently unknown. Techniques involving local anaesthetic, such as pectoral plane (PECs) blocks and infusion pumps, are growing in popularity, as they reduce the amount of opioid medications used. Opioids are associated with nausea, vomiting, low blood pressure, drowsiness and constipation, and as such, opioid-sparing analgesic regimens postoperatively are becoming more common. These regimens will typically involve paracetamol, a NSAID (non-steroidal anti-inflammatory drug), and a local anaesthetic technique.

Pectoral plane blocks involve a once-off injection of local anaesthetic at two locations within the chest wall, typically done after the patient undergoes general anaesthesia, but before the commencement of surgery. Local anaesthetic infusion pumps involve the insertion of a catheter into the wound at the end of surgery, before the patient emerges from general anaesthesia, that constantly emit local anaesthetic over a defined period of time. Each technique is considered extremely safe, and is considered acceptable as a form of pain relief in patients undergoing breast surgery.

There are no published works comparing pectoral plane blocks with local anaesthetic infusion pump analgesia, and the investigators see a gap in the knowledge base that can be addressed. This study will allow efficacy, safety and cost of the three techniques to be compared. The investigators feel the study design is robust, and statistical analysis based on previously published works in the area of postoperative analgesia has allowed the study to be powered appropriately.

Patients undergoing breast surgery are a vulnerable group, and this is recognised via the provision of a comprehensive Patient Information Leaflet and a commitment to respecting the process of Informed Consent. The investigators also recognise this is a stressful period in a woman's life, and the study will be conducted in a sensitive and compassionate manner.

The study has been designed to be prospective, randomised, and double-blinded. The anaesthetic will be standardised in relation to analgesic and anti-emetic agents administered, in order to minimise variables. Chronic post-surgical pain is a growing area of research, and the follow-up telephone interview at 3-months will allow investigation of this.

A Data Record Form will be utilised for data collection, which will subsequently be analysed statistically. Data will be handled sensitively, securely, and by the minimum number of researchers. A plan is in place for destruction of data at an appropriate time.

While there will be no direct benefit to participants, including monetary considerations, this research study will add to the knowledge-base surrounding analgesia for breast surgery.

Methods The Mater Misericordiae University Hospital's Institutional Review Board (IRB) approved this study; reference number 1/378/1840, dated December 21st, 2016. It was registered with clinicaltrials.gov; reference number NCT03024697, dated February 15th, 2017. Forty-five ASA I-III female patients aged 18 years or older, undergoing non-ambulatory breast cancer surgery under general anaesthesia between January and May 2017 were included. All participants provided informed written consent.

Non-ambulatory breast cancer surgery encompassed wide-local excision with lymph node resection, simple mastectomy, and mastectomy with lymph node resection. Those undergoing latissimus dorsi or DIEP (deep inferior epigastric perforator) flap reconstruction were excluded. Patients with chronic pain syndromes, local anaesthetic allergy, contraindication to simple analgesics, local infection over the proposed block site, coagulopathy, or co-morbid conditions precluding the provision of informed consent, were excluded. All patients were day of surgery admission and attended a preoperative anaesthetic assessment clinic.

Patients were allocated into three groups using computer-generated randomisation, with the study number and group allocation concealed in sealed envelopes. Blocked randomisation in groups of 9 was applied, giving similar numbers in each group as the study progressed. Groups were named 'PECs', 'Local anaesthetic infusion (LA infusion)' , and 'Both (PECS \& LA infusion)', which were evenly distributed to opaque envelopes numbered one to forty-five in accordance with randomisation. The randomisation key was held by an independent party, and was not used to reveal participant group allocations until data analysis commenced. 'PECs' patients received PECS I \& II blocks and a sham wound infiltration catheter. 'LA infusion' patients received a continuous local anaesthetic wound infusion catheter. 'PECs \& LA infusion' patients received a combination of techniques, without the initial local anaesthetic bolus via the wound infusion catheter. PECs blocks were performed while patients were under general anaesthesia, prior to the commencement of surgery. The operative surgeon sited wound infusion catheters during skin closure at the end of surgery.

Patients were induced with fentanyl 1-2 μg.kg-1, followed by propofol titrated to the absence of verbal response. Anaesthesia was maintained using an oxygen, air and sevoflurane combination. Airway management and lung ventilation strategies were at the discretion of the supervising anaesthetist. Patients received a standard intraoperative analgesic regimen of paracetamol 1g and dexketoprofen 50mg intravenously (IV), with rescue morphine as deemed necessary. Combination antiemetics, including ondansetron 0.1-0.15 mg.kg-1 IV, dexamethasone 0.1-0.2 mg.kg-1 IV or droperidol 0.01-0.015 mg.kg-1 IV, were administered according to patient risk factors. Intraoperative management was otherwise left to the discretion of the supervising anaesthetist. Routine monitoring was used in accordance with AAGBI guidelines15. An electronic anaesthetic record was used to document physiological parameters. Perioperative events, such as induction of anaesthesia, initial skin incision, and end of surgery, were annotated on the record.

PECs I \& II blocks were performed on the side of surgery, using the ultrasound-guided technique described by Blanco et al9, 10. The patient was placed in the supine, head-up, position with the arm abducted. The skin was prepared with chlorhexidine gluconate 2%/isopropyl alcohol 70% (BD, ChloraPrep, NJ, USA). PECs blocks were performed with a 22-gauge echogenic needle (B. Braun, Ultraplex 360 cannula, Hessen, Germany; 50-80mm), using the same ultrasound machine (Sonosite Edge, Sonosite, Inc., Bothwell, WA, USA) and transducer (Sonosite HFL 50x, Sonosite, Inc., Bothwell, WA, USA). The ultrasound probe was placed inferolaterally at the mid-clavicular level. The axillary artery and vein were identified, and the probe moved laterally until pectoralis major, pectoralis minor and serratus anterior muscles were located at the level of the 3rd rib. A needle in-plane approach was taken until the needle tip was positioned in the plane between pectoralis major and minor muscles, and levobupivacaine 0.25% 10ml was injected. The needle was advanced until it occupied the space between pectoralis minor and serratus anterior muscles, and a further 20ml of levobupivacaine 0.25% was injected.

Blinding was not considered necessary for 'LA infusion' group patients, as PECs blocks were performed under general anaesthesia. All patients had a wound infusion catheter sited and attached to an elastometric pump (B. Braun, ON-Q PainBuster, Hessen, Germany), which was placed by the operating surgeon during skin closure at the end of surgery. For blinding purposes, patients in the 'PECs' group received a sham wound infiltration catheter system. 'LA infusion' and 'PECS \& LA infusion' patients received levobupivacaine 0.1% at 10ml.hr-1 for 24 hours postoperatively, while 'PECs' patients received sodium chloride 0.9% at the same rate. 'LA infusion' patients were administered an initial bolus of levobupivacaine 0.25% 20ml at the end of surgery. Those who performed the procedures, or were involved in the perioperative management, were not involved in postoperative pain assessment or data collection. Study interventions as described occurred while patients were under general anaesthesia.

Patients were monitored for 24 hours after surgery, initially in the post-anaesthesia care unit (PACU), and then at ward level once PACU discharge criteria were met. Oxycodone 1-2mg IV as required was prescribed for rescue analgesia in the PACU. A standard analgesic protocol of paracetamol 1g PO/IV 6-hourly regular, ibuprofen 400mg PO 8-hourly regular, and oxycodone immediate release (oxynorm) 5-10mg 1-hourly as required for rescue analgesia, was prescribed for all patients. Ondansetron 4-8mg IV 8-hourly as required was prescribed, to be administered in the event of postoperative nausea and vomiting (PONV).

The primary outcome measure of the study was area under curve of verbal rating score (VRS) of pain moving versus time, (AUC) where VRS pain was measured at 1 hour, 4-6 hours, 10-14 hours, and 20-24 hours postoperatively. At each assessment, patients were invited to report their pain VRS pain at rest. Pain while moving was defined as pain experienced while sitting forward from a recumbent position. Secondary outcome measures were total opioid consumption over a 24-hour period and presence of adverse events. An investigator masked to group allocations recorded vital signs, pain scores, antiemetic administration and opioid use postoperatively. Adverse events such as sedation, respiratory depression, hypotension, pruritus and PONV were also recorded.

Statistical Analysis

Data was analysed by Graph Pad Prism v6 (Salt Lake City, UH). The primary end-point was area under the VRS moving versus time curve (AUC). We powered the study to detect a 25% difference in AUC from an internal pilot study which indicated mean AUC of 60 cm.hr-1 (SD 5-10) among patients receiving PECs or LA infusion in our clinical service, to 45 cm.hr-1. We had observed the standard deviation of the AUC to be in the order of 15 cm.hr-1. Assuming a Type I error of 0.05 and a Type II error of 0.1, then n=11 patients would be required each group to detect this difference with 90% power. We obtained IRB permission for n=15 each group to allow for protocol violations or patient drop-out.

Data was collected at 1, 4-6, 12-14 and 20-24 hr, post-operatively. It was tested for distribution initially using the Kolmogorov-Smirnov test. For each patient, their AUC both moving and at rest was calculated by plotting their pain VRS versus time using Graph Pad Prism v.6. The mean AUC according to the three study groups was then calculated and inspected for distribution as described above, and all AUC data was found to be normally distributed. Therefore, AUC data is expressed as mean ± SD and was compared using ANOVA with post hoc Bonferroni correction. Non-normally distributed data was compared using the Kruskal-Wallis test for repeated measurements. Categorical data (e.g. the incidence of potential adverse effects) were compared using Fischer's exact test where appropriate. P\<0.05 was deemed statistically significant.

Single-shot Pectoral Plane(PECs) Block Versus Continuous Local Anaesthetic Infusion Analgesia or Both PECS Block and Local Anaesthetic Infusion After Breast Surgery: A Prospective Randomised, Double-blind Trial

Single-shot Pectoral Plane (PECs) Blocks Versus Continuous Local Anaesthetic Infusion Analgesia or Both PECs Block and Local Anaesthetic Infusion After Non-ambulatory Breast Cancer Surgery: A Prospective, Randomised, Double-blind Trial

IPD will not be made available to other researchers as this has been pre-determined with patients as part of the process of informed consent.

Mater Misericordiae University Hospital

Dr. Sean Keane; Anaesthesia SpR

Infections

Respiratory Tract (Lung and Bronchial) Diseases

Ear, Nose, and Throat Diseases

Digestive System Diseases

Mouth and Tooth Diseases

Chronic Disease

Rhinitis

Rhinosinusitis

Nasal Polyps

Ganglion Cysts

Synovial Cyst

Cysts

Colorectal Neoplasms

Nasopharyngeal Neoplasms

Polyps

Communicable Diseases

Respiratory Tract Infections

Nose Diseases

Respiratory Tract Diseases

Otorhinolaryngologic Diseases

Disease Attributes

Sinusitis

Paranasal Sinus Diseases

Mucinoses

Connective Tissue Diseases

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Colonic Diseases

Intestinal Diseases

Rectal Diseases

Pharyngeal Neoplasms

Otorhinolaryngologic Neoplasms

Head and Neck Neoplasms

Nasopharyngeal Diseases

Pharyngeal Diseases

Stomatognathic Diseases

Pathological Conditions, Anatomical

Chronic Graft Versus Host Disease

Anti-Inflammatory Agents

Antirheumatic Agents

Analgesics

Vasoconstrictor Agents

Respiratory System Agents

Adjuvants, Anesthesia

Anticonvulsants

Antiemetics

Muscle Relaxants, Central

Psychotropic Drugs

Gastrointestinal Agents

Vasodilator Agents

Ibuprofen

Epinephrine

Botulinum Toxins

Botulinum Toxins, Type A

abobotulinumtoxinA

Diclofenac

Diazepam

Racepinephrine

Epinephryl borate

Acetylcholine

Cholinergic Agents

Neurotransmitter Agents

* Preoperative medication: Paracetamol 1,5g oral, diclofenac 50mg (evt ibuprofen 600mg) oral and/or diazepam 5-10 mg oral.
* Skin and tissue inside the projected injection canal will be infiltrated with 5-10ml Marcain-Adrenalin (5mg/ml + 5microg/ml) for local anaesthesia.
* Localization will be confirmed with help of navigation before the medication will be given. Intravascular injection will be prevented by control of aspiration.

botox injection under CT/MR navigation and with the navigation tool MultiGuide

botox injection Multiguide

Lars Jacob Stovner, md prof

Chronic rhinosinusitis (CRS) with nasal polyps is a particularly challenging form of chronic rhinosinusitis in several ways. Patients have significantly more severe symptom burden and worse quality of life than patients with chronic rhinosinusitis without nasal polyps. Many patients return to the health care providers with persistent symptoms after repeated medical and surgical treatment. Patients have usually tried several different types of treatments, ranging from less invasive procedures to extensive surgical treatment. The surgical treatment is often repeated several times. The most common surgical treatment is functional endoscopic sinus surgery, another established procedure is Vidian neurectomy.

The main object of this pilot study is to investigate the safety of onabotulinumtoxin A towards the sphenopalatine ganglion (SPG) in CRS patients with nasal polyps. Efficacy data will also be collected to provide indication on whether future placebo-controlled studies should be performed.

Onabotulinumtoxin A inhibits the secretion of acetylcholine, blocking the parasympathetic reflex cascade in the SPG. As a result, the investigators expect less mucosal swelling, secretion and nasal polyps. The duration of such a blockade is believed to last for 3-9 months and will not lead to damage of the nerve.

This study opens up for improved treatment with less complications.

Botulinum Toxin Type A Block of the Sphenopalatine Ganglion in Chronic Rhinosinusitis With Nasal Polyposis

Registration of all adverse events sorted by probable relation to botox or surgery. Data collected from symptom diary, in addition to an open question at consultation and put into the Case Report Form (CRF) by physician or nurse.

St. Olavs Hospital

Norwegian University of Science and Technology

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Ultrasound-guided Erector Spinae Plane Block Versus Transversus Abdominis Plane Block for Postoperative Analgesia of Adult Patients Undergoing Ovarian Cancer Surgery	NCT04434339	Postoperative P...	erector spinae ... transversus abd...	18 Years - 65 Years	Cairo University
3 Ultrasound Guided Plane Blocks for Perioperative Analgesia in Patients Undergoing Radical Cystectomy	NCT05278598	Cancer, Bladder Surgery Anesthesia Analgesia Block	Erector Spinae ... Thoracic Parave... Quadratus Lumbo...	18 Years -	Cairo University
Ultrasound-guided Erector Spinae Plane Block Versus Transversus Abdominis Plane Block for Postoperative Analgesia of Adult Patients Undergoing Ovarian Cancer Surgery	NCT04434339	Postoperative P...	erector spinae ... transversus abd...	18 Years - 65 Years	Cairo University
Ultrasound-guided Erector Spinae Plane Block Versus Transversus Abdominis Plane Block for Postoperative Analgesia of Adult Patients Undergoing Ovarian Cancer Surgery	NCT04434339	Postoperative P...	erector spinae ... transversus abd...	18 Years - 65 Years	Cairo University
Single-shot Pectoral Plane(PECs) Block Versus Continuous Local Anaesthetic Infusion Analgesia or Both PECS Block and Local Anaesthetic Infusion After Breast Surgery: A Prospective Randomised, Double-blind Trial	NCT03024697	Breast Diseases Anesthesia Block	Pectoral Plane ... Local Anaesthet...	18 Years -	Mater Misericordiae University Hospital
3 Ultrasound Guided Plane Blocks for Perioperative Analgesia in Patients Undergoing Radical Cystectomy	NCT05278598	Cancer, Bladder Surgery Anesthesia Analgesia Block	Erector Spinae ... Thoracic Parave... Quadratus Lumbo...	18 Years -	Cairo University
Single-shot Pectoral Plane(PECs) Block Versus Continuous Local Anaesthetic Infusion Analgesia or Both PECS Block and Local Anaesthetic Infusion After Breast Surgery: A Prospective Randomised, Double-blind Trial	NCT03024697	Breast Diseases Anesthesia Block	Pectoral Plane ... Local Anaesthet...	18 Years -	Mater Misericordiae University Hospital
Botulinum Toxin Type A Block of the Sphenopalatine Ganglion in Chronic Rhinosinusitis With Nasal Polyposis	NCT02784262	Chronic Disease Nasal Polyposis Rhinitis	botox injection...	18 Years - 70 Years	Norwegian University of Science and Technology

Spots Global Cancer Trial Database for block

Every month we try and update this database with for block cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Spots Global Cancer Trial Database for block

Every month we try and update this database with for block cancer trials from around the world to help patients and their families find trials that might be right for them. We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Every month we try and update this database with for block cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.