Bilateral External Oblique Intercostal Plane Block in Post Operative Pain Management in Hepatectomy

NCT06822309 | Not Yet Recruiting DMC

• 1 other identifier: MS-189-2024
• Study Type: interventional
• Target: 40
• Locations: 0 countries
• Sites: N/A

Brief Summary

The majority of cases undergoing hepatectomy suffer from inadequate postoperative analgesia. Therefore, multimodal analgesic techniques are required to relieve pain and discomfort such as intravenous, and epidural analgesia, and peripheral nerve blocks. Although epidural catheters are efficient to provide perioperative analgesia, in this type of surgery patients may be more susceptible to catheter related complications due to the alteration in coagulation parameters. That is why safer alternatives are sought for those patients. The use of patient-controlled analgesia (PCA) for postoperative pain management improves patients' quality of recovery. However, there are many concerns regarding the type of opioids used in PCA such as overdosing, underdosing, and the effect of the hepatectomy on the drug metabolism in those patients. External oblique intercostal plane block (EOI block) is a relatively novel block used in upper abdominal incisions especially subcostal laparotomy to provide intraoperative and postoperative analgesia. This study aims to compare the efficacy of Bilateral External Oblique Intercostal Plain Block versus PCA in pain management and reduction of opioid use in hepatectomy surgery done by subcostal incision.

Conditions

Provide Post Hepatectomy Pain Control

Keywords

External Oblique Intercostal block; subcostal incision; hepatectomy; Patient control analgesia

Outcome Measures

Primary Outcomes (1)

• • Rescue morphine consumption in both groups. (Total consumption of morphine rescue shots in milligram in first 2r hours)

  twenty four hours.

Study Arms (2)

External Oblique Intercostal Plane block

EXPERIMENTAL

Patients in this group will receive External Oblique Intercostal plane block intraoperatively before the surgery.

Procedure: External Oblique Intercostal Plane Block

Patient controlled analgesia

ACTIVE COMPARATOR

Patient will be on patient control analgesia after the surgery.

Device: Patient controlled analgesia

Interventions

External Oblique Intercostal Plane Block PROCEDURE

The block is performed before skin incision by a specialized anesthetist. With the patient positioned in the supine position with their ipsilateral arm abducted, the skin was sterilized, using the high frequency linear probe (M-Turbo HF 38 transducer 13- 6 MHz) of Fujifilm Sonosite ultrasound is placed over the sixth rib medial to the anterior axillary line approximately in midclavicular line in a parasagittal orientation. A 20-guage needle is inserted in a cephalocaudal direction, and the external oblique intercostal plane was hydro dissected with saline. After hydro dissection, the needle is advanced 1 to 2 cm, and 20 mL of 0.25% bupivacaine (Sunny Pharmaceutical) with 4 mg dexamethasone as an additive was administered. The same procedure will be done at the other side (bilateral external oblique intercostal plane block).

External Oblique Intercostal Plane block

Patient controlled analgesia DEVICE

Patients in group will receive intravenous patient controlled analgesia device 100 ml (Accuafuser 100 mL, basal rate 4 mL/hr., bolus 0.5 mL/time, and lock time 15 minutes) for postoperative pain management that will contain 30 mg morphine (loading dose0.1mg/kg) will be given by infusion over 10 minutes then accuafuser will be connected),8 mg dexamethasone and 8 mg ondansetron diluted in 100 ml saline.

Patient controlled analgesia

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age ≥ 18 and ≤ 65 Years.
• Both sexes.
• Patients will be scheduled for hepatectomy surgery.
• Body mass index (BMI) 18.5-30.0 /m 2 .

You may not qualify if:

• Extension of the surgical incision beyond coverage of T12 dermatome.
• Prolonged time of surgery \> 5 hours.
• Hepatectomy surgery combined with another organ resection.
• Patients with hypersensitivity to local anesthetics.
• History of psychiatric problems.
• Recent history of analgesic drugs including opioid abuse or addiction.
• Coagulopathy (International normalized ratio \[INR\] \> 1.4).
• Localized infection at the block site.
• Morbidly obese patients.

Sponsors & Collaborators

• Sherif Alaa Embaby: lead

Related Publications (1)

• Cosarcan SK, Ercelen O. The analgesic contribution of external oblique intercostal block: Case reports of 3 different surgeries and 3 spectacular effects. Medicine (Baltimore). 2022 Sep 9;101(36):e30435. doi: 10.1097/MD.0000000000030435.

  PMID: 36086688 BACKGROUND

MeSH Terms

Interventions

Analgesia, Patient-Controlled

Intervention Hierarchy (Ancestors)

Analgesia; Anesthesia and Analgesia

Central Study Contacts

Sherif A Embaby, Consultant

CONTACT

+447777918923; sherif.embaby@kasralainy.edu.eg

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Consultant of Anaesthesia, ICU and pain management.

Study Record Dates

• First Submitted: February 6, 2025
• First Posted: February 12, 2025
• Study Start: April 1, 2025
• Primary Completion: October 1, 2025
• Study Completion: November 1, 2025
• Last Updated: February 12, 2025

Record last verified: 2025-02