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This study aims to compare the analgesic efficacy, duration of analgesia, and overall opioid consumption between the external oblique intercostal plane (EOIP) block and subcostal transversus abdominis plane (TAP) block in patients undergoing laparoscopic sleeve gastrectomy.
Postoperative pain management is a critical aspect of enhanced recovery after surgery (ERAS) protocols, particularly in laparoscopic bariatric procedures such as sleeve gastrectomy.
Among the ultrasound-guided abdominal wall blocks, the transversus abdominis plane (TAP) block and its subcostal variant have demonstrated efficacy for upper abdominal surgeries. The subcostal TAP block provides analgesia for the T6-T9 dermatomes, covering incisions in upper abdominal procedures like laparoscopic cholecystectomy and bariatric surgery.
The external oblique intercostal plane (EOIP) block is a relatively new fascial plane block that targets the intercostal nerves lying between the external oblique and intercostal muscles.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| EOIP Group (Group A ) | Experimental | Patients will receive an ultrasound-guided bilateral external oblique intercostal plane (EOIP) block using 20 mL of 0.25% bupivacaine in each side after induction of anesthesia and prior to surgical incision. |
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| Subcostal TAP Group (Group T) | Experimental | Patients will receive a bilateral subcostal transversus abdominis plane (TAP) block using 20 mL of 0.25% bupivacaine in each side, under ultrasound guidance and identical conditions. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| External oblique intercostal plane block | Other | Patients will receive an ultrasound-guided bilateral external oblique intercostal plane (EOIP) block using 20 mL of 0.25% bupivacaine in each side after induction of anesthesia and prior to surgical incision. |
| Measure | Description | Time Frame |
|---|---|---|
| Total morphine consumption | Patient-controlled analgesia (PCA) using intravenous morphine (1 mg bolus, 10-minute lockout) will be available for rescue analgesia when visual analogue score ( VAS ) > 3. | 24 hours postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Time to first rescue analgesia | Time to first rescue analgesia will be recorded from the end of surgery till first dose of morphine administrated. | 24 hours postoperatively |
| Degree of pain | Each patient will be instructed about postoperative pain assessment with the visual analogue score (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS will be recorded at 0, 2, 6, 12, and 24 hours postoperatively (at rest and cough). |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ahmed A Ali, MBBCH | Contact | 00201067850909 | macisosevo@gmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Benha University | Recruiting | Banhā | Benha | 13518 | Egypt |
The data will be available upon a reasonable request from the corresponding author after the end of study for one year.
After the end of study for one year.
The data will be available upon a reasonable request from the corresponding author.
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| Subcostal transversus abdominis plane block | Other | Patients will receive a bilateral subcostal transversus abdominis plane (TAP) block using 20 mL of 0.25% bupivacaine in each side, under ultrasound guidance and identical conditions. |
|
| 24 hours postoperatively |
| Heart rate | Heart rate will be recorded intraoperatively and postoperatively | Till the end of surgery (Up to two hours) |
| Mean arterial blood pressure | Mean arterial blood pressure will be recorded intraoperatively and postoperatively | Till the end of surgery (Up to two hours) |
| Incidence of postoperative nausea and vomiting | Incidence of postoperative nausea and vomiting (PONV) will be recorded. | 24 hours postoperatively |
| Block-related complications | Block-related complications such as pleural puncture, local anesthetic toxicity, and hematoma will be recorded. | 24 hours postoperatively |
| Degree of patient satisfaction | Patient satisfaction will be assessed using a 5-point Likert scale at 24 hours (1 = very dissatisfied , 2 = dissatisfied, 3 =mild, 4= moderate satisfaction, 5 = very satisfied ). | 24 hours postoperatively |