External Oblique Intercostal Plane Block, Laparoscopic Sleeve Gastrectomy, Perioperative Analgesia, Subcostal Transversus Abdominis Plane Block, Ultrasound
Conditions
Brief summary
This study aims to compare the analgesic efficacy, duration of analgesia, and overall opioid consumption between the external oblique intercostal plane (EOIP) block and subcostal transversus abdominis plane (TAP) block in patients undergoing laparoscopic sleeve gastrectomy.
Detailed description
Postoperative pain management is a critical aspect of enhanced recovery after surgery (ERAS) protocols, particularly in laparoscopic bariatric procedures such as sleeve gastrectomy. Among the ultrasound-guided abdominal wall blocks, the transversus abdominis plane (TAP) block and its subcostal variant have demonstrated efficacy for upper abdominal surgeries. The subcostal TAP block provides analgesia for the T6-T9 dermatomes, covering incisions in upper abdominal procedures like laparoscopic cholecystectomy and bariatric surgery. The external oblique intercostal plane (EOIP) block is a relatively new fascial plane block that targets the intercostal nerves lying between the external oblique and intercostal muscles.
Interventions
OTHERExternal oblique intercostal plane block
Patients will receive an ultrasound-guided bilateral external oblique intercostal plane (EOIP) block using 20 mL of 0.25% bupivacaine in each side after induction of anesthesia and prior to surgical incision.
Patients will receive a bilateral subcostal transversus abdominis plane (TAP) block using 20 mL of 0.25% bupivacaine in each side, under ultrasound guidance and identical conditions.
Sponsors
Benha University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age from 18 to 65 years. * Both genders. * American Society of Anesthesiologists (ASA) class I or II * Body mass index (BMI) between 30-50 kg/m². * Scheduled for elective laparoscopic sleeve gastrectomy under general anesthesia. * Written informed consent from patients or surrogate decision makers.
Exclusion criteria
* Patient refusal. * Allergy to local anesthetics. * Coagulation disorders or anticoagulant therapy. * Local infection or scar at the injection site. * Severe hepatic or renal dysfunction. * Chronic opioid use or psychiatric illness interfering with pain assessment. * Conversion to open surgery or intraoperative complications requiring re-exploration.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total morphine consumption | 24 hours postoperatively | Patient-controlled analgesia (PCA) using intravenous morphine (1 mg bolus, 10-minute lockout) will be available for rescue analgesia when visual analogue score ( VAS ) \> 3. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to first rescue analgesia | 24 hours postoperatively | Time to first rescue analgesia will be recorded from the end of surgery till first dose of morphine administrated. |
| Degree of pain | 24 hours postoperatively | Each patient will be instructed about postoperative pain assessment with the visual analogue score (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS will be recorded at 0, 2, 6, 12, and 24 hours postoperatively (at rest and cough). |
| Heart rate | Till the end of surgery (Up to two hours) | Heart rate will be recorded intraoperatively and postoperatively |
| Mean arterial blood pressure | Till the end of surgery (Up to two hours) | Mean arterial blood pressure will be recorded intraoperatively and postoperatively |
| Incidence of postoperative nausea and vomiting | 24 hours postoperatively | Incidence of postoperative nausea and vomiting (PONV) will be recorded. |
| Block-related complications | 24 hours postoperatively | Block-related complications such as pleural puncture, local anesthetic toxicity, and hematoma will be recorded. |
| Degree of patient satisfaction | 24 hours postoperatively | Patient satisfaction will be assessed using a 5-point Likert scale at 24 hours (1 = very dissatisfied , 2 = dissatisfied, 3 =mild, 4= moderate satisfaction, 5 = very satisfied ). |
Countries
Egypt
Contacts
CONTACTAhmed A Ali, MBBCH
Outcome results
None listed