External Oblique Intercostal Plane Block Versus Subcostal Transversus Abdominis Plane Block in Supra-umbilical Surgical Incisions

Pain, Postoperative Clinical Trial

Official title:

External Oblique Intercostal Plane Block Versus Subcostal Transversus Abdominis Plane Block in Supra-umbilical Surgical Incisions; Randomized Controlled Double Blinded Clinical Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05432557
• Other study ID #: RC 1-5-2022
• Status: Completed
• Phase: N/A
• Start date: June 20, 2022
• Est. completion date: April 20, 2023

Study information

• Verified date: June 2023
• Source: Benha University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Various newer techniques have been proposed to enhance analgesia in upper abdominal region. The subcostal transverse abdominis plane (SCTAP) block is the deposition of local anesthetic in the transverse abdominis plane inferior and parallel to the costal margin. There is a growing consensus that the SCTAP block provides better analgesia for upper abdominal incisions than the traditional transverse abdominis plane block.

The External oblique intercostal plane (EOIP) block is a novel technique reported by Hamilton et al. performed EOPB by administering LA superior or deep of the external oblique muscle from the sixth intercostal space leading to the blockage of thoracoabdominal nerves at T6-T10. It has several attractive aspects such as easy sono-anatomy ribs one strip of muscle so easy to demonstrate even in obese patients, there is a bony backstop, easy expandable fascial plane that can accommodate a catheter and it is shallow block with no big vessels nearby.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 60
• Est. completion date: April 20, 2023
• Est. primary completion date: December 10, 2022
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 20 Years to 60 Years

Eligibility

Inclusion Criteria:

1. American Society of Anesthesiologists (ASA) physical status grade I -II,

2. Scheduled to undergo elective supra-umbilical surgeries under GA (epigastric herniotomy- gastrectomy- open cholecystectomy- nephrectomy).

Exclusion Criteria:

1. Allergy to local anesthetics,

2. Infection at the site of injection,

3. Coagulopathy,

4. Chronic pain syndromes,

5. Prolonged opioid medication,

6. Patients who received any analgesic 24 h before surgery.

7. Chronic liver disease, chronic renal disease, and cognitive impairment.

Related Conditions & MeSH terms

• Pain, Postoperative
• Surgical Wound

Intervention

Procedure:
• external oblique intercostal plain block (EOIP)
A high-frequency linear ultrasound probe will be placed in a longitudinal parasagittal orientation at the sixth intercostal space in the anterior midaxillary line. A 21G 10 cm needle will be inserted using an in plane approach. The tip of the needle will be placed into the fascial plane on the deep aspect of the external oblique muscle. A volume of 20 mL of LA mixture (10 mL of bupivacaine 0.5%, 5 mL of lidocaine 2% and 5 mL of normal saline to make a mixture totaling 20 ml.) will be injected.
• subcostal transversus abdominis plane block (SCTAP)
The US probe will be placed immediately below the costal margin on oblique plane toward the lateral close to midline to identify the rectus abdominis muscle. The transversus abdominis muscle will be identified lying posterior to the rectus muscle. An 8cm 22-gauge block needle will be inserted using an in- plane approach. transversus abdominis plane will be accessed by placing the needle adjacent to costal margin but medial to linea semilunaris. The needle will be advanced slowly in-plane to promote hydrodissection along the oblique subcostal line. A volume of 20 mL of LA mixture (10 mL of bupivacaine 0.5%, 5 mL of lidocaine 2% and 5 mL of normal saline to make a mixture totaling 20 ml.) will be injected.

Other:
• control group
No LA injection

Locations

Country	Name	City	State
Egypt	Samar Rafik Amin	Banha	Qalubia

Sponsors (1)

Lead Sponsor	Collaborator
Benha University

Country where clinical trial is conducted

Egypt, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	amount of postoperative morphine consumed		24 hours postoperatively
Primary	First postoperative analgesics request		24 hours postoperatively
Secondary	Postoperative pain score	pain evaluated by VAS (visual analogue score).	at 1, 2,4 , 8, 16 and 24 hours postoperatively
Secondary	Incidence of Postoperative nausea & vomiting (PONV)	Number of patients developing PONV	24 hours postoperatively
Secondary	incidence of complications related to the block	agitation, dizziness, tinnitus, tremors, and numbness.	24 hours postoperatively