Cardiac Electrophysiology, Cholecystectomy, Laparoscopic, Electrocardiography, Pain, Postoperative, Regional Anesthesia
Conditions
Keywords
Erector Spinae Plane Block (ESP block), Frontal QRS-T Angle, Postoperative Pain Control, Cardiac Risk, Ultrasound-guided Nerve Block, QT interval
Brief summary
This study aims to investigate the effects of preoperative and postoperative Erector Spinae Plane (ESP) block on the frontal QRS-T angle, a marker of cardiac electrophysiological instability, in patients undergoing laparoscopic cholecystectomy. A total of 120 patients aged 18-65 with ASA I-II status will be randomized into three groups: Control (no ESP), Preoperative ESP, and Postoperative ESP. Electrocardiograms (ECGs) will be obtained preoperatively and one hour postoperatively to assess changes in QRS-T angle and other repolarization parameters. This randomized controlled trial will help clarify the potential cardiac effects of ESP block depending on its timing and may provide insight into optimizing anesthetic safety in surgical patients.
Detailed description
Erector Spinae Plane (ESP) block is widely used in laparoscopic surgeries for postoperative pain control due to its simplicity and efficacy. However, its influence on the autonomic nervous system and subsequent cardiovascular effects, including changes in cardiac electrophysiological parameters, remains insufficiently understood. The frontal QRS-T angle has emerged as a novel and reliable ECG-derived marker associated with increased cardiac risk and ventricular repolarization heterogeneity. This prospective, randomized, controlled, single-center trial aims to evaluate the impact of ESP block timing on the frontal QRS-T angle. A total of 120 adult patients scheduled for elective laparoscopic cholecystectomy will be randomly assigned into three groups: Control group (no ESP block), Preoperative ESP block group, Postoperative ESP block group. Bilateral ESP blocks will be administered using 0.25% bupivacaine under ultrasound guidance at the T7 level. Standard general anesthesia will be applied to all patients. ECG recordings will be obtained preoperatively and at the first postoperative hour to calculate the frontal QRS-T angle, QT interval, QTc, Tp-e, Tp-e/QT, and Tp-e/QTc ratios. The primary outcome is the change in the frontal QRS-T angle. Secondary outcomes include pain scores (VAS), analgesic consumption, and other ECG-based repolarization markers. The findings may enhance perioperative cardiac risk stratification and inform decisions on the optimal timing of ESP block administration in surgical patients with potential cardiac vulnerability.
Interventions
This procedure involves bilateral ultrasound-guided erector spinae plane block at the T7 level using 20 mL of 0.25% bupivacaine per side (total 40 mL) before the induction of general anesthesia. The intervention aims to evaluate the effects of preoperative ESP block on changes in frontal QRS-T angle and other ECG-derived cardiac electrophysiological parameters.
Patients in this group will undergo standard general anesthesia. At the end of the surgery, bilateral ESP block will be performed under ultrasound guidance at the T7 level using 0.25% bupivacaine (20 mL per side, total 40 mL). The aim is to evaluate the effect of postoperative ESP block on changes in frontal QRS-T angle and other cardiac electrophysiological parameters.
PROCEDUREStandard General Anesthesia
This group will receive standard general anesthesia without any additional regional block. ECG data will be collected preoperatively and 1 hour postoperatively to serve as a comparison for electrophysiological changes observed in the intervention groups.
DRUGBupivacaine
0.25% bupivacaine, 20 mL per side (total 40 mL), administered bilaterally at T7 level under ultrasound guidance as part of ESP block.
Sponsors
Harran University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
This is an open-label study due to the nature of the ESP block procedure, which prevents blinding of participants and care providers.
Intervention model description
Participants will be randomly assigned into three parallel groups to compare the effects of preoperative and postoperative erector spinae plane block on cardiac electrophysiological parameters.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age between 18-65 years * ASA physical status I-II * Scheduled for elective laparoscopic cholecystectomy * Voluntary written informed consent obtained * Normal preoperative 12-lead ECG (no conduction abnormalities or arrhythmias)
Exclusion criteria
* History of cardiac disease (e.g., arrhythmia, myocardial infarction, heart failure) * Current use of medications affecting cardiac conduction (e.g., antiarrhythmics, beta-blockers) * Known allergy to local anesthetics * Coagulation disorders or current anticoagulant therapy * Pregnancy or breastfeeding * Local infection or anatomical deformity at the ESP block injection site * Patients with psychiatric or neurological disorders impairing cooperation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Frontal QRS-T Angle Between Preoperative and Postoperative ECG | From 1 hour before surgery to 1 hour after surgery | The primary outcome is the change in frontal QRS-T angle measured on 12-lead ECG before surgery (baseline) and 1 hour after laparoscopic cholecystectomy. This angle is a marker of ventricular repolarization heterogeneity and potential cardiac risk. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in QT Interval (QTc) Pre- and Postoperatively | From 1 hour before surgery to 1 hour after surgery | The corrected QT interval (QTc) will be measured on 12-lead ECG before and 1 hour after surgery to evaluate changes in ventricular repolarization associated with ESP block. |
| Postoperative Pain Intensity Based on Visual Analog Scale (VAS) | At 2, 6, 12, and 24 hours postoperatively | Pain intensity will be assessed using the 10 cm Visual Analog Scale (VAS), ranging from 0 (no pain) to 10 (worst imaginable pain), at rest and during coughing at 2, 6, 12, and 24 hours postoperatively. Higher scores indicate worse pain. |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORVeli F Pehlivan, Asiss Prof
Harran University Faculty of Medicine, Department of Anesthesiology
Outcome results
None listed