The goal of this clinical trial is to compare the degree of pain relief between two techniques of regional anesthesia given to ladies undergoing hysterectomy under general anesthesia.
One group of patients will have a local anesthetic injected between muscle layers in their back (ultrasound guided Erector Spinae plane Block).
The other group will have a local anesthetic injected around specific nerves in their abdomen (ultrasound guided Ilio-hypogastric / ilio-inguinal nerve block ).
Researchers will compare the duration of postoperative pain relief , the degree of pain relief and any possible side effects of either techniques.
Adult female patients above the age of 35 years.
American Society of Anesthesiologists (ASA) physical status I-II.
Patient refusal.
History of allergy or intolerance to study medications.
Chronic opioid use (>3 months).
Severe renal or hepatic impairment.
Parallel
Nerve Block
Other interventionIlioinguinal/ Iliohypogastric nerve block: In the supine position, the ultrasound probe probe is positioned in a transverse manner, superior to the anterior superior iliac spine. The three anterior abdominal muscle layers are identified, and the two nerves are identified in the abdominal neurovascular plane. A echogenicneedle is inserted in a medial-to-lateral direction. After negative aspiration, 5 ml saline is injected to ensure correct needle tip position then 20 ml of bupivacaine 0.25% is injected gradually close to the nerves. Erector spinae plane block: In a lateral position, the erector spinae is visualized about 3 cm lateral to T7-T9 spinous processes on the target side. A echogenic needle (50 mm/22 gauge) is advanced in a cephalad to caudad direction until the tip reaches the plane deep to the erector spinae muscle immediately lateral to the transverse process. A 20 ml bupivacaine 0.25% is injected gradually into this plane.
The time to first call for analgesia.
The period of time starting from extubation until the patient asks for analgesia in hours.
postoperative pain score
Visual analog scale (0-100 mm)
intraoperative hemodynamic changes
Increase in heart rate(beat/min) or systolic blood pressure(mmHg) more than 20% of the baseline , hypotension (defined as a decrease in mean arterial pressure \> 25% from the baseline value or systolic arterial pressure \< 100 mmHg),
Total post-operative opioid consumption
The total Rescue analgesia boluses of morphine ( 0.1mg/kg if the VAS exceeded 3 \& repeated until the VAS dropped below 3.
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