Rectus Sheath Block Versus Transversus Abdominis Plane Block for Analgesia in Laparoscopic Bariatric Surgery

NCT07592091 | Not Yet Recruiting

• 1 other identifier: ANE-2568-0679
• Study Type: interventional
• Target: 96
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled trial aims to compare the analgesic efficacy of rectus sheath block (RSB) and transversus abdominis plane block (TAPB) in patients undergoing laparoscopic bariatric surgery. Both techniques are regional anesthesia methods used as part of multimodal analgesia to reduce postoperative pain and opioid requirements. Eligible participants will be randomly assigned to receive either a RSB or a TAPB after general anesthesia. Postoperative pain scores, opioid consumption, recovery outcomes, area of sensory loss, time to first rescue analgesia, and block-related adverse events will be assessed and compared between the two groups. This study will help determine which regional anesthesia technique provides more effective postoperative analgesia for laparoscopic bariatric surgery

Conditions

Rectus Sheath Block; Opioid Consumption, Postoperative; Analgesia; Transverse Abdominis Plane Block

Keywords

Rectus Sheath Block; Transversus abdominis plane block; Laparoscopic bariatric surgery; opioid consumption; analgesia

Outcome Measures

Primary Outcomes (1)

• Pain intensity during movement at 6 hours postoperatively (Pain-move-6hour)

  Pain intensity will be assessed using the Numerical Rating Scale (NRS), an 11-point scale ranging from 0 to 10, where 0 indicates no pain and 10 represents the worst pain imaginable. Patients will be asked to rate their pain intensity by selecting the number that best reflected their level of pain during movement at 6 h postoperatively. Patients will be instructed to perform a standardized movement (including coughing, deep breathing, or changing position from supine to sitting) and then rate the pain intensity experienced during that movement.

  6 hours postoperatively

Secondary Outcomes (8)

• Pain intensity at rest and during movement

  0, 2, 6, 12, 24, and 48 hours postoperatively

• Intraoperative fentanyl consumption

  During intraoperative period

• Area of sensory loss

  30 minutes postoperatively

• Time to first rescue analgesia

  within 48 hours postoperatively

• Postoperative opioid consumption

  0-24 hours and 24-48 hours postoperatively

Study Arms (2)

Rectus Sheath Block Group

EXPERIMENTAL

Participants in this group will receive bilateral ultrasound-guided rectus sheath block using 30 mL of 0.25% bupivacaine with epinephrine 5 µg/mL on each side, in addition to standard perioperative multimodal analgesia.

Procedure: Rectus Sheath Block

Transversus Abdominis Plane Block Group

ACTIVE COMPARATOR

Participants in this group will receive bilateral ultrasound-guided transversus abdominis plane block using 30 mL of 0.25% bupivacaine with epinephrine 5 µg/mL on each side, in addition to standard perioperative multimodal analgesia.

Procedure: Transversus Abdominis Plane Block

Interventions

Rectus Sheath Block PROCEDURE

Bilateral rectus sheath block will be performed by an anesthesiologist experienced in ultrasound-guided regional anesthesia. The ultrasound probe will be positioned at the midpoint between the xiphoid process and the umbilicus along the mid-clavicular line. After aseptic preparation of the puncture site and ultrasound probe, a needle will be advanced using an in-plane, lateral-to-medial approach under continuous ultrasound guidance. After correct needle-tip placement between the rectus abdominis muscle and the posterior rectus sheath, 30 mL of 0.25% bupivacaine with epinephrine 5 µg/mL will be injected on each side after negative aspiration. Local anesthetic spread will be monitored in real time, and the procedure will be repeated on the contralateral side using the same technique.

Rectus Sheath Block Group

Transversus Abdominis Plane Block PROCEDURE

Bilateral transversus abdominis plane block will be performed by an anesthesiologist experienced in ultrasound-guided regional anesthesia. The ultrasound probe will be placed on the lateral abdominal wall between the costal margin and iliac crest at the mid-axillary line. Depth, frequency, and gain will be adjusted to clearly visualize the fascial plane between the internal oblique and transversus abdominis muscles. After aseptic preparation of the puncture site and ultrasound probe, a needle will be advanced using an in-plane approach under continuous ultrasound guidance. After correct needle-tip placement in the transversus abdominis plane, 30 mL of 0.25% bupivacaine with epinephrine 5 µg/mL will be injected on each side after negative aspiration. Local anesthetic spread within the fascial plane will be monitored in real time, and the procedure will be repeated on the contralateral side using the same technique.

Transversus Abdominis Plane Block Group

Eligibility Criteria

• Age: 20 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Patients aged 20-60 years old
• Scheduled for elective LBS including laparoscopic sleeve gastrectomy, proximal jejunal bypass, and Roux-en-Y gastric bypass
• American Society of Anesthesia (ASA) physical status III
• Have ability to communicate and understand the study and accept to participate in the study

You may not qualify if:

• Patients who have following underlying disease: severe hepatic impairment \[diagnosed of cirrhosis (Child-Pugh C)\], coagulopathy (diagnosed of disease associated with abnormal coagulation), pre-existing neurological deficits, chronic pain (diagnosed of chronic pain disease or current use regular analgesic drugs), or any drug addiction.
• Known allergy to bupivacaine or weighing less than 60 kg, as the planned doses of bupivacaine may exceed safe maximum limits.
• Patient with previous foregut surgery including esophageal, gastric, liver and pancreases resection.

Sponsors & Collaborators

• Chiang Mai University: lead

Study Sites (1)

Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University

Chiang Mai, Mueang, 50200, Thailand

Location

Related Publications (2)

• Xue Q, Chu Z, Zhu J, Zhang X, Chen H, Liu W, Jia B, Zhang Y, Wang Y, Huang C, Hu X. Analgesic Efficacy of Transverse Abdominis Plane Block and Quadratus Lumborum Block in Laparoscopic Sleeve Gastrectomy: A Randomized Double-Blinded Clinical Trial. Pain Ther. 2022 Jun;11(2):613-626. doi: 10.1007/s40122-022-00373-1. Epub 2022 Mar 21.

  PMID: 35312948 RESULT

• Samerchua A, Tepmalai K, Chakrabandhu B, Supphapipat K, Lapisatepun P, Leurcharusmee P, Prapussarakul K, Jinadech T, Jungsakulrujirek K, Wanvoharn M. Analgesic Effect of Rectus Sheath Block Versus Local Infiltration Analgesia in Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Trial. Obes Surg. 2026 Jan;36(1):182-192. doi: 10.1007/s11695-025-08405-3. Epub 2025 Dec 4.

  PMID: 41345817 RESULT

MeSH Terms

Conditions

Agnosia

Condition Hierarchy (Ancestors)

Perceptual Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Kittitorn Supphapipat, MD

  Department of Anesthesiology, Faculty of Medicine, Chiang Mai University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Kittitorn Supphapipat, MD

CONTACT

+66891920066; kittitorn.pans@gmail.com

Artid Samerchua, MD

CONTACT

+66826944496; artidsamerchua@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Instructor, Department of Anesthesiology, Faculty of Medicine, Chiang Mai University

Model Details: Participants will be randomly assigned in a 1:1 ratio to receive either rectus sheath block or transversus abdominis plane block. Outcomes will be assessed at multiple postoperative time points

Study Record Dates

• First Submitted: May 6, 2026
• First Posted: May 18, 2026
• Study Start: May 10, 2026
• Primary Completion (Estimated): December 31, 2030
• Study Completion (Estimated): June 30, 2031
• Last Updated: May 18, 2026

Record last verified: 2026-04

Locations

TH (1)