Comparative Effects of Erector Spinae Plane Block and External Oblique Intercostal Plane Block on Postoperative Respiratory Recovery Following Liver Resection: A Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 116
- 试验地点
- 1
- 主要终点
- Right diaphragmatic excursion
研究概览
简要总结
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Diagnostic
- 盲法
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 75 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •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.
排除标准
- •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.
研究组 & 干预措施
The external oblique intercostal plane (EOIP) block
newer fascial plane block that targets the thoracoabdominal nerves within the fascial plane between the external oblique and intercostal muscles. Its dermatomal coverage, typically spanning T6 to T10-T11, corresponds well with common upper abdominal surgical incisions. Emerging randomized data indicate that EOIP block provides effective postoperative analgesia and may be faster and technically easier to perform than deeper blocks. In open liver surgery, where subcostal and J-shaped incisions are frequently used, the EOIP block appears anatomically well-matched to the surgical field .
干预措施: Ultrasound-guided bilateral external oblique intercostal plane (EOIP) block (Procedure)
The erector spinae plane (ESP) block
gained widespread use due to its relative technical simplicity, safety profile, and potential to provide both somatic and visceral analgesia. Meta-analytic evidence suggests that ESP block reduces postoperative opioid consumption and pain scores in abdominal surgery compared with control or alternative techniques.
干预措施: Ultrasound-guided bilateral erector spinae plane (ESP) block (Procedure)
结局指标
主要结局
Right diaphragmatic excursion
时间窗: 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.
次要结局
- 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).)
- Mean cumulative postoperative opioid consumption and Mean intraoperative opioid consumption(First 24 postoperative hours.)
- Number of participants requiring supplemental oxygen(First 24 postoperative hours.)
- Number of participants with early postoperative pulmonary complications(Within 7 postoperative days.)
- Mean lung ultrasound score(During the first 24 postoperative hours at predefined assessment time points.)
研究者
Nevine Mostafa Soliman
Ass. Prof.
Menoufia University