Liver Resection, Upper Abdominal Surgeries
Conditions
Brief summary
This study evaluates respiratory recovery as a multidimensional construct using clinically relevant and measurable parameters, including LUS, diaphragmatic excursion, oxygen requirement, and PPCs. The investigators hypothesize that bilateral ESP block improves postoperative respiratory function compared with EOIP block following open hepatic surgery. The investigators further hypothesize that this improvement is mediated, in part, by superior analgesia.
Interventions
PROCEDUREUltrasound-guided bilateral external oblique intercostal plane (EOIP) block
Bilateral ESP block * after induction of general anesthesia and before surgical incision. * T7 or T8 transverse process, selected consistently by protocol. * high-frequency linear probe when feasible; curvilinear probe in larger habitus. In-plane cranial-to-caudal or caudal-to-cranial approach to the fascial plane deep to erector spinae muscle and superficial to the transverse process. * Injectate: 20 mL of 0.25% bupivacaine per side after negative aspiration; hydrodissection used to confirm correct plane. Bilateral EOIP block * after induction of general anesthesia and before surgical incision. * ultrasound-guided injection into the fascial plane between the external oblique muscle and the intercostal muscle/external intercostal membrane near the 6th-8th intercostal spaces on each side, following the institutional standardized approach. * Injectate: 20 mL of 0.25% bupivacaine per side Safter negative aspiration.
PROCEDUREUltrasound-guided bilateral erector spinae plane (ESP) block
An ultrasound-guided bilateral ESP block will be performed after induction of general anaesthesia and before surgical incision. The block will be administered at the T7 or T8 transverse process using an in-plane ultrasound-guided approach. Twenty millilitres of 0.25% bupivacaine will be injected on each side into the fascial plane deep to the erector spinae muscle and superficial to the transverse process after negative aspiration. Correct spread of local anaesthetic will be confirmed by hydrodissection.
Sponsors
Menoufia University
National Liver Institute, Egypt
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Adult patients aged 18-75 years * Adult with American Society of Anesthesiologists (ASA) physical status I-III * Scheduled for elective hepatic surgery via upper abdominal incisions will be eligible. * All participants will be required to understand the Numeric Rating Scale (NRS) and provide informed consent.
Exclusion criteria
* Patient refusal * Coagulopathy (INR\>1.4 or platelet count\<8 x 104) * Contraindications to fascial plane blocks * Infection at the puncture site * Known allergy to study medications * Chronic opioid use or chronic pain syndromes * Severe chronic respiratory failure requiring home oxygen or noninvasive ventilation * Pregnancy * Body mass index\>40 kg/m² * When ultrasound imaging will be deemed unreliable * Emergency surgery * Hemodynamic instability * Reoperation during the same hospital admission. * Patients scheduled preoperatively for elective postoperative mechanical ventilation or planned ICU intubation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Right diaphragmatic excursion | Baseline, and 1, 6, and 24 hours after surgery. | Right diaphragmatic excursion will be measured during quiet tidal breathing in the semi-recumbent position using M-mode ultrasonography through a right subcostal hepatic acoustic window. Three consecutive respiratory cycles will be recorded and averaged at each assessment measured in cm. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean postoperative pain intensity at rest, during coughing or deep breathing | Pain scores at rest (PACU 30 minutes, 2, 6, 12, and 24 hours) and during coughing or deep breathing (6, 12, and 24 hours). | Postoperative pain intensity at rest will be assessed using the Numeric Rating Scale NRS score 0-10. Postoperative pain intensity during coughing or deep breathing will be assessed using the Numeric Rating Scale NRS score 0-10. |
| Mean cumulative postoperative opioid consumption and Mean intraoperative opioid consumption | First 24 postoperative hours. | Total cumulative opioid consumption during the first 24 postoperative hours. Measured in Morphine milligram equivalents (MME). Total opioid administered during the intraoperative period from induction of anesthesia until completion of surgery. Measured in Morphine milligram equivalents (MME). |
| Number of participants requiring supplemental oxygen | First 24 postoperative hours. | Number of participants requiring supplemental oxygen or escalation of oxygen therapy beyond standard postoperative care to maintain peripheral oxygen saturation (SpO₂) ≥94%, according to institutional postoperative care protocols. Number of participants (%) |
| Number of participants with early postoperative pulmonary complications | Within 7 postoperative days. | Number of participants who develop early postoperative pulmonary complications within 7 days after surgery, including clinically significant atelectasis. Number of participants (%) |
| Mean lung ultrasound score | During the first 24 postoperative hours at predefined assessment time points. | Lung ultrasound score will be assessed using a standardized 12-zone protocol lung ultrasound score 0-36. |
Countries
Egypt
Contacts
CONTACTNevine Mostafa Soliman
Outcome results
None listed