Non-opioid Anesthesia Based on Thoracic Paravertebral Block During Laparoscopic Sleeve Gastrectomy

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A vizsgálat olyan elhízott felnőtteket keres, akiknél laparoszkópos gyomorrezekciót (sleeve gastrectomia, fogyást segítő gyomorműtét) terveznek. Háromféle altatási módot hasonlít össze.

Életkor

18 évtől 70 évig

Nem

Mindkét nemű résztvevő csatlakozhat.

A betegség stádiuma

A testtömegindex (BMI) legalább 30 kg/m². ASA 2-3 állapot. Laparoszkópos sleeve gastrectomia (LSG) van betervezve.

Korábbi kezelés

Korábban többszakmás elhízáskezelő csapat kezelésében kellett részt vennie.

A részvétel fő kizáró okai

• Allergia a tervezett gyógyszerekre
• Nem kezelt (nem kontrollált) pszichiátriai betegség
• Koponyán belüli betegség vagy agyi érkárosodás
• Bármi, ami akadályozza a megfelelő kommunikációt
• Fertőzés a szúrás helyén (a paravertebrális blokkos csoportban)

A regiszter feltételei, szó szerint

Nézd meg, megfelelhetsz-e

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• 18 és 70 év között vagy?IgenNem

Mit akar kideríteni a vizsgálat

Regional anesthesia is a technique in which a local anesthetic is injected near a nerve or spinal cord to block sensation, motor stimulation, and pain. In this study, an ultrasound-guided paravertebral block will be used, with careful consideration of all positive and negative factors and possible complications. A thoracic paravertebral block is performed by inserting a needle into the intercostal spaces on the back, approximately 4 cm lateral to the spine. Many studies support excellent pain control with this technique, during and after surgery in thoracic and abdominal surgery. Investigators aim to achieve faster patient mobility after surgery, rapid recovery of bowel function, reduced nausea and vomiting, and maximum pain control. The use of opioids, which can additionally cause respiratory suppression and drowsiness, is avoided.

A vizsgálat 3 csoportja

• Opioid based anesthesia (OBA)Már használt kezelés, összehasonlításként

  Premedication: pantoprazole 40 mg i.v. 1h before surgery. Following three-minute preoxygenation, sufentanil (5 to 15 micrograms), propofol (1 to 2 mg/kg ideal body weight), and rocuronium (0.8 to 1 mg/kg ideal body weight) are administered intravenously during induction of anesthesia. Anesthesia is sustained with sevoflurane maintained at 0.6-1.3 MAC. Sufentanil is added at the assessment of the anesthesiologist in the operating room. To prevent postoperative nausea and vomiting (PONV), patients receive intraoperatively dexamethasone (8 mg), ondansetron (4 mg), and metoclopramide (10 mg) intravenously. Intraoperative pain management includes metamizole (2.5 g) and acetaminophen (1 g). For pain levels of 4 or higher on a numerical rating scale (NRS), treatment options include metamizole (2.5 g), pethidine (25 to 100 mg), or tramadol (100 mg). For nausea and vomiting, intravenous doses of ondansetron or metoclopramide are provided as needed.

  Kezelés: Sufentanil, Opioid based Anesthesia, Metoclopramide 10mg, Ondasetron 4mg és Dexamethasone, 8 mg intravenously

• Opioid free anesthesia (OFA) based on lidocain, dexmedetomidine and S-ketamineMár használt kezelés, összehasonlításként

  Premedication: pregabalin 75 mg peroraly et pantoprazole 40mg i.v. A pre-prepared 50 ml syringe is utilized, containing 400 mcg of dexmedetomidine (4 ml), 50 mg of S-ketamine (2 ml), 400 mg of 2% lidocaine (20 ml), and 0.9% NaCl to a total volume of 40 ml. Anesthesia is commenced with the infusion from syringe 1 over a 10-minute period at a rate of 15 ml/hour. After this initial period, anesthetic induction is conducted using propofol at a dose of 1-2 mg/kg IBW and rocuronium at 0.8-1 mg/kg IBW. Anesthesia is sustained with sevoflurane maintained at 0.5-1 MAC, adjusted per BIS readings. The anesthetic mixture was maintained at a rate of 5-10 ml per hour adjusted according to the patient's blood pressure and pulse. Intraoperative pain management includes metamizole (2.5 g) and acetaminophen (1 g). To prevent nausea and vomiting, patients receive intraoperative dexamethasone 8 mg and thiethylperazine 6.5 mg intravenously.

  Kezelés: Dexmedetomidin, ketamine, Lidocain, Opioid free anesthesia, Opioid free anesthesia based on intravenous dexmedetomidine, ketamine and lidocainedexmedetomidine, ketamine and lidocaine, Thiethylperazine és Dexamethasone, 8 mg intravenously

• Opioid free anesthesia based on thoracic paravertebral block (TPVB)A vizsgált kezelés

  Premedication: pantoprazol 40mg i.v. Preoperative TPVB is executed at the Th5, Th7, and Th9 levels bilaterally. The skin at each level are infiltrated with 1.5 ml of 1% lidocaine. Subsequently, 10 ml of 0.33% levobupivacaine, combined with 1.33 mg of dexamethasone and 40 mcg of adrenaline, is injected at each level and flushed with 1 ml of 5% glucose. In the operating room a induction is carried out with propofol administered at a dosage of 2-2.5 mg/kg of ideal body weight (IBW) and rocuronium at 0.8-1 mg/kg of IBW. Anesthesia is maintained with an infusion of propofol at 100 mcg/kg of total body weight (TBW) per minute, with adjustments made to achieve a targeted BIS value between 40-60. Intraoperative pain management includes metamizole (2.5 g) and acetaminophen (1 g). Prophylaxis of PONV is dexamethasone 8 mg previously administered within the thoracic paravertebral block, with intraoperative administration of 10 mg metoclopramide. Completely opioid-free interventions.

  Kezelés: Levobupivacaine, Dexamethasone contained in the solution for thoracic paravertebral block, Adrenaline, Opioid free anesthesia based on thoracic paravertebral block, Ultrasound guided thoracic paravertebral block, Nerve stimulator for peripheral nerve blocks és Metoclopramide 10mg