CTRI Number |
CTRI/2021/03/031983 [Registered on: 15/03/2021] Trial Registered Prospectively |
Last Modified On: |
17/04/2024 |
Post Graduate Thesis |
Yes |
Type of Trial |
Interventional |
Type of Study
|
Surgical/Anesthesia |
Study Design |
Randomized, Parallel Group Trial |
Public Title of Study
|
To compare the effect of depositing drug below erector spinae and rhomboid muscles using ultrasound in relieving pain after breast cancer surgery |
Scientific Title of Study
|
A Comparison of ultrasound guided Erector spinae plane block versus Rhomboid intercostal block for perioperative analgesia in Breast cancer Surgery: A Randomized controlled trial |
Trial Acronym |
|
Secondary IDs if Any
|
Secondary ID |
Identifier |
NIL |
NIL |
|
Details of Principal Investigator or overall Trial Coordinator (multi-center study)
|
Name |
Dr Satish kumar |
Designation |
Junior Resident |
Affiliation |
AIIMS PATNA |
Address |
Department of Anesthesiology AIIMS PATNA PHULWARISHARIF PATNA BIHAR Patna BIHAR 801507 India |
Phone |
8210014760 |
Fax |
|
Email |
satish.psc@gmail.com |
|
Details of Contact Person Scientific Query
|
Name |
Dr Shagufta Naaz |
Designation |
Associate Professor |
Affiliation |
AIIMS PATNA |
Address |
Department of Anesthesiology AIIMS PATNA Phulwarisharif Patna Bihar Patna BIHAR 801507 India |
Phone |
7765937919 |
Fax |
|
Email |
drshaguftanaaz@gmail.com |
|
Details of Contact Person Public Query
|
Name |
Dr Shagufta Naaz |
Designation |
Associate Professor |
Affiliation |
AIIMS PATNA |
Address |
Department of Anesthesiology AIIMS PATNA Phulwarisharif Patna Bihar Rohtas BIHAR 801507 India |
Phone |
7765937919 |
Fax |
|
Email |
drshaguftanaaz@gmail.com |
|
Source of Monetary or Material Support
|
|
Primary Sponsor
|
Name |
AIIMS PATNA |
Address |
PHULWARISHARIF PATNA BIHAR PIN 801507 |
Type of Sponsor |
Research institution and hospital |
|
Details of Secondary Sponsor
|
|
Countries of Recruitment
|
India |
Sites of Study
|
No of Sites = 1 |
Name of Principal
Investigator |
Name of Site |
Site Address |
Phone/Fax/Email |
Dr Satish Kumar |
AIIMS PATNA |
Department of Anesthesiology
AIIMS Patna Patna BIHAR |
8210014760
satish.psc@gmail.com |
|
Details of Ethics Committee
|
No of Ethics Committees= 1 |
Name of Committee |
Approval Status |
Institutional Ethics Committee AIIMS Patna |
Approved |
|
Regulatory Clearance Status from DCGI
|
|
Health Condition / Problems Studied
|
Health Type |
Condition |
Patients |
(1) ICD-10 Condition: C509||Malignant neoplasm of breast of unspecified site, |
|
Intervention / Comparator Agent
|
Type |
Name |
Details |
Intervention |
Ultrasound guided Erector spinae plane block |
Ultrasound guided Erector spinae plane block will be administered after induction of general anesthesia for perioperative analgesia in breast cancer surgery. |
Comparator Agent |
Ultrasound guided Rhomboid intercostal block |
Ultrasound guided Rhomboid intercostal block will be administered after induction of general anesthesia for perioperative analgesia in breast cancer surgery. |
|
Inclusion Criteria
|
Age From |
18.00 Year(s) |
Age To |
70.00 Year(s) |
Gender |
Female |
Details |
1.Female with breast cancer undergoing unilateral Modified Radical Mastectomy (MRM) or Breast conservative surgery with sentinel lymph node dissection.
2.American society of anesthesiologist (ASA) physical status Ç€ and Ç.
3.BMI 18-24.9 kg/m2
|
|
ExclusionCriteria |
Details |
1. Patients with coagulation disorder
2. Chronic opioid use
3. Allergy to local anaesthetic
4. Procedure site infection
5. History of previous mastectomy
6. Severe spine/chest wall deformity
|
|
Method of Generating Random Sequence
|
Computer generated randomization |
Method of Concealment
|
Sequentially numbered, sealed, opaque envelopes |
Blinding/Masking
|
Participant, Investigator and Outcome Assessor Blinded |
Primary Outcome
|
Outcome |
TimePoints |
Perioperative opioid consumption |
From administer of the regional block to 24 hours postoperatively |
|
Secondary Outcome
|
Outcome |
TimePoints |
1.Time of first rescue analgesia
2.NRS Pain score |
1.From 0 to 24 hours postoperatively
2.Postoperatively at 0,1,2,4,6,12 and 24 h. |
|
Target Sample Size
|
Total Sample Size="76" Sample Size from India="76"
Final Enrollment numbers achieved (Total)= "0"
Final Enrollment numbers achieved (India)="84" |
Phase of Trial
|
N/A |
Date of First Enrollment (India)
|
22/03/2021 |
Date of Study Completion (India) |
30/07/2022 |
Date of First Enrollment (Global) |
Date Missing |
Date of Study Completion (Global) |
Date Missing |
Estimated Duration of Trial
|
Years="1" Months="0" Days="0" |
Recruitment Status of Trial (Global)
Modification(s)
|
Not Applicable |
Recruitment Status of Trial (India) |
Completed |
Publication Details
|
|
Individual Participant Data (IPD) Sharing Statement
|
Will individual participant data (IPD) be shared publicly (including data dictionaries)?
Response - NO
|
Brief Summary
Modification(s)
|
Introduction: Breast cancer is the one of the most frequently diagnosed cancers among women in the world. It is overall the second most common cancer in the world. Now it has become the most common cancer among women in the developing world.1 Treatment modality for breast cancer includes primarily surgery (mastectomy), with or without chemotherapy, and/or radiotherapy but severe acute postoperative pain is a high concern for approximately half of all breast surgery patients.2 For a long time, various regional anesthesia techniques including thoracic paravertebral block, Erector spinae plane block, Pecs block etc has been used for perioperative analgesia in breast cancer surgery to decrease opioid consumption and its side effect. Following endotracheal intubation, patients in the group A will be positioned in lateral decubitus with the involved breast lying superiorly. The spine will be palpated from C7 (most prominent spinous process) to T5 and point will be marked to identify the spinous process. Ultrasound-guided EPSB will be performed by Paramedian sagittal scan with in-plane needle insertion from cranial to caudal. Following endotracheal intubation, patients in the group B will be positioned in lateral decubitus with the involved breast lying superiorly. The ipsilateral arm will be moved across the chest to move the scapula away and open up the triangle of auscultation (TOA) space (Figure 2). The TOA is located along the lower medial border of the scapula. It is bounded superiorly by the trapezius, inferiorly by the latissimus dorsi, and laterally by the vertebral border of the scapula. Rhomboid intercostal block will be performed aseptically by an anaesthesiologist experienced with the performance of RIB.
· Problem statement: Breast cancer surgery is associated with acute and chronic postoperative pain which is a significant concern. Inadequate postoperative pain control may hamper early recovery and discharge. High dose of opioid consumption for perioperative analgesia in breast cancer surgery increases PONV, tolerance and respiratory depression and may delay recovery. Therefore, effective and safe multimodal analgesia is required to control postoperative acute pain and reduce opioid consumption. · Rationale– Ultrasound guided ESPB and RIB are effective, safe and new regional block techniques for postoperative analgesia to control acute postoperative pain which help in early recovery and patient satisfaction which is a significant concern in breast cancer surgery. Both reduce postoperative opioid consumption and their side effects. But it is not known which among the two has better analgesic efficacy. · Novelty - Currently many regional block techniques are in practice for perioperative analgesia in breast cancer surgery but none of them can be considered as gold standard. Ultrasound guided ESPB and RIB are relatively new and safe regional blocks for major thoracic surgery. This study is one of its kind in which we will compare perioperative analgesic efficacy of the two blocks. · Research question: Does ultrasound guided ESPB provide more effective perioperative analgesia than RIB in breast cancer surgery? · Research hypothesis: Ultrasound guided ESPB provides more effective perioperative analgesia than RIB in breast cancer surgery. · Aim – To compare ultrasound guided Erector spinae plane block versus Rhomboid intercostal block for perioperative analgesia in breast cancer surgery. · Primary Objective: To compare opioid consumption between ultrasound guided ESPB versus RIB for perioperative analgesia in breast cancer surgery. · Secondary Objective : 1. To compare the time to first rescue analgesia. 2. To compare postoperative pain score at 0,1,2,4,6,12 and 24 h. |