External Oblique Intercostal Block Versus Erector Spinae Plane Block on Postoperative Pain in Laparoscopic Radical Gastrectomy

Official title

Effects of Ultrasound-guided External Oblique Intercostal Block Versus Erector Spinae Plane Block on Postoperative Pain in Laparoscopic Radical Gastrectomy

Overview

Postoperative pain is highly prevalent following laparoscopic radical gastrectomy. Although the erector spinae plane block (ESPB) can effectively alleviate this pain, it still has many limitations. The external oblique intercostal plane block (EOIB) is a novel nerve block technique that may provide well postoperative analgesia for upper abdominal surgery. Therefore, this study employs a non-inferiority randomized controlled trial design to verify that the analgesic effect of EOIB is not inferior to that of ESPB, thereby offering more options for regional analgesia strategies in laparoscopic radical gastrectomy.

Detailed description

Laparoscopic radical gastrectomy (including subtotal and total gastrectomy) is the most commonly used surgical approach for gastric cancer. Although this technique is less invasive than traditional open surgery, more than 50% of patients still experience moderate to severe acute pain in the early postoperative period, making effective postoperative pain management essential. Regional nerve blockade techniques have become a key component of postoperative analgesia due to their reliable analgesic effect and significant reduction in opioid consumption.

The erector spinae plane block (ESPB) is considered a relatively safe nerve block for upper abdominal surgery analgesia. However, the spread of the local anesthetic and the resulting block effect are unpredictable. Moreover, ESPB cannot be performed with the patient in the supine position and may present technical challenges in obese patients.

The external oblique intercostal plane block (EOIB) is a recently proposed regional block technique for the upper abdomen. This block involves injecting local anesthetic into the superficial fascial plane between the external oblique muscle and the intercostal muscles, thereby blocking the anterior rami and cutaneous branches of the intercostal nerves from T6-T10, which can provide effective analgesia for upper abdominal incision areas.

Nevertheless, current research on the analgesic effect of EOIB after laparoscopic radical gastrectomy remains limited, particularly lacking high-quality, prospective, randomized controlled studies to verify whether EOIB can achieve analgesic effects comparable to those of ESPB. Therefore, this study adopts a non-inferiority randomized controlled trial design to verify that the postoperative analgesic effect of EOIB is not inferior to that of ESPB, providing more options for regional analgesia strategies in laparoscopic radical gastrectomy.

Interventions

• Procedure External Oblique Intercostal Plane Block
  With the patient in the supine position, a high-frequency linear array probe (6-15 MHz) is used to perform a sagittal parasagittal oblique scan at the level of the 6th rib, between the right anterior axillary line and midclavicular line. The external oblique muscle, intercostal muscles, and ribs are identified. Using an in-plane technique, a 21G, 100mm block needle is inserted from a superomedial to inferolateral direction, with the needle tip positioned in the plane between the external oblique
• Procedure Erector Spinae Plane Block (ESPB) group
  With the patient in the lateral decubitus position (surgical side up), a low-frequency convex array probe (2-5 MHz) is used to perform a sagittal scan approximately 2-3 cm lateral to the spinous process of T8 or T9. The transverse process and the erector spinae muscle are identified. Using an out-of-plane technique, a 21G, 100mm block needle is advanced until contact is made with the transverse process. The needle is then withdrawn 1-2 mm to position its tip within the fascial plane deep to the

Primary outcome measures

• Cumulative opioid consumption within 24 hours postoperatively [Time frame: 24 hours after surgery]

Secondary outcome measures (3)

• Pain Intensity [Time frame: 2, 6, 12, 24, 48, and 72 hours postoperatively]
• Quality of Recovery [Time frame: 24,48,72 hours after surgery]
• sleep quality [Time frame: 24,48,72 hours after surgery]

Eligibility criteria

Inclusion criteria

• Patients aged over 18 years
• Classified as ASA I-III
• Scheduled for elective laparoscopic radical gastrectomy under general anesthesia
• Voluntarily participated and provided written informed consent.

Exclusion criteria

• Chronic opioid dependence or prior use of analgesic medications for >3 months;
• Inability to communicate due to severe dementia, language barriers, or terminal illness;
• History of central and/or peripheral nervous system disorders;
• Severe renal insufficiency (serum creatinine >442 μmol/L or requiring renal replacement therapy) or severe hepatic insufficiency (Child-Pugh class C);
• Allergy to local anesthetics.
• Expected to be transferred to ICU after surgery.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Double blind

Primary purpose

Treatment

Study locations

China · 1 center

• General hospital of Ningxia medical university — Yinchuan

Identifiers

NCT: NCT07396545 · Lingzi-2026-1

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗