External Oblique Intercostal Block for Postoperative Pain After Laparoscopic Cholecystectomy: A Randomized Controlled Trial
Overview
- Phase
- Not Applicable
- Status
- Not yet recruiting
- Sponsor
- Shiyou Wei
- Enrollment
- 56
- Locations
- 1
- Primary Endpoint
- Total Butorphanolconsumption in the first 24 hours after surgery
Overview
Brief Summary
This prospective, randomized, controlled, assessor-blinded trial will evaluate whether bilateral ultrasound-guided external oblique intercostal block (EOIB) reduces postoperative opioid consumption and improves pain control after laparoscopic cholecystectomy, compared with no block.
Detailed Description
Laparoscopic cholecystectomy is a common procedure, yet postoperative pain remains clinically significant despite routine multimodal analgesia, and opioid use may cause adverse effects. External oblique intercostal block (EOIB) is a newer ultrasound-guided fascial plane block that may provide effective analgesia for upper abdominal surgery.
This study is a prospective, randomized, controlled, assessor-blinded trial in patients undergoing elective laparoscopic cholecystectomy. A total of 56 participants will be randomized 1:1 to receive either bilateral ultrasound-guided EOIB or no regional block. EOIB will be performed bilaterally under ultrasound guidance at the level of the 6th rib in the 6th-7th intercostal space using an in-plane technique, with 15 mL of study local anesthetic mixture injected per side. Postoperatively, all participants will receive standardized multimodal analgesia, including intravenous patient-controlled analgesia (PCA) with butorphanol and non-opioid analgesics per protocol.
The primary outcome is total opioid consumption during the first 24 hours after surgery. Secondary outcomes include postoperative pain scores (VRS) at prespecified time points, quality of recovery (QoR-15) at 24 hours, opioid consumption from 24-48 hours, postoperative nausea and vomiting, intraoperative hemodynamic events, time to first flatus, and length of hospital stay. The trial aims to determine whether adding bilateral EOIB to standard analgesia can reduce opioid requirements and improve recovery after laparoscopic cholecystectomy.
Note for your protocol alignment: your document contains a potential inconsistency about "no other opioids within 72 hours" versus recording "rescue opioid" use; you may want to standardize this wording before final submission.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Outcomes Assessor)
Masking Description
Outcome assessors are blinded to group assignment. Participants and clinical care providers/investigators are not blinded because the control group does not receive a regional block.
Eligibility Criteria
- Ages
- 18 Years to 85 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Aged 18-85 years, regardless of gender
- •American Society of Anesthesiologists (ASA) physical status classification I-III
- •Scheduled for elective laparoscopic cholecystectomy
- •Ability to use the intravenous patient-controlled analgesia (IV PCA) system
Exclusion Criteria
- •Hepatic disease (e.g., liver enzyme levels ≥ 2× the upper limit of normal)
- •Renal disease (e.g., serum creatinine levels ≥ 2× the upper limit of normal)
- •Allergy or known hypersensitivity to local anesthetics
- •Females who are pregnant or lactating
- •Conversion to open surgery
- •Coagulopathy or current use of anticoagulant medications
- •Opioid use for more than 2 weeks in the past 6 months
Arms & Interventions
EOIB Group
Participants receive bilateral ultrasound-guided external oblique intercostal block (EOIB) (15 mL of the study local anesthetic mixture per side) in addition to standard general anesthesia and standardized postoperative analgesia (IV PCA butorphanol ).
Intervention: External oblique intercostal block (EOIB) (Other)
Control Group
Participants do not receive any regional block. They receive standard general anesthesia and standardized postoperative analgesia only (IV PCA butorphanol).
Intervention: Standard care without regional block (Other)
Outcomes
Primary Outcomes
Total Butorphanolconsumption in the first 24 hours after surgery
Time Frame: 0-24 hours after surgery
Total Butorphanol consumption during the first 24 hours postoperatively. A relative difference of 30% is considered clinically significant.
Secondary Outcomes
- Pain score (VRS) at 24 hours after surgery(24 hours after surgery)
- Quality of recovery at 24 hours (QoR-15 score)(24 hours after surgery)
- Postoperative length of hospital stay(Within 7 days after surgery)
- Butorphanol consumption from 24 to 48 hours after surgery(24-48 hours after surgery)
- Incidence of intraoperative hypotension and hypertension(Intraoperative period)
- Pain score (VRS) at 48 and 72 hours after surgery(48 hours and 72 hours after surgery)
- Incidence of postoperative nausea and vomiting within 72 hours(1-6 hours, 7-24 hours, 25-48 hours, and 49-72 hours after surgery (up to 72 hours))
- Time to first flatus(Within 3 days after surgery)
Investigators
Shiyou Wei
Principal Investigator
Shanghai Pulmonary Hospital, Shanghai, China