Ultrasound-Guided External Oblique Intercostal Plane Block Versus Subcostal Transversus Abdominis Plane Block For Perioperative Analgesia in Laparoscopic Sleeve Gastrectomy
Overview
- Phase
- Not Applicable
- Status
- Recruiting
- Sponsor
- Benha University
- Enrollment
- 70
- Locations
- 1
- Primary Endpoint
- Total morphine consumption
Overview
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.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Double (Participant, Outcomes Assessor)
Eligibility Criteria
- Ages
- 18 Years to 65 Years (Adult, Older Adult)
- Sex
- All
- Accepts 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.
Arms & Interventions
EOIP Group (Group A )
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.
Intervention: External oblique intercostal plane block (Other)
Subcostal TAP Group (Group T)
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.
Intervention: Subcostal transversus abdominis plane block (Other)
Outcomes
Primary Outcomes
Total morphine consumption
Time Frame: 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 Outcomes
- Time to first rescue analgesia(24 hours postoperatively)
- Degree of pain(24 hours postoperatively)
- Heart rate(Till the end of surgery (Up to two hours))
- Mean arterial blood pressure(Till the end of surgery (Up to two hours))
- Incidence of postoperative nausea and vomiting(24 hours postoperatively)
- Block-related complications(24 hours postoperatively)
- Degree of patient satisfaction(24 hours postoperatively)
Investigators
Ahmed Alaa El din Ali
Resident of Anesthesiology, Egypt.
Benha University