This randomized clinical trial aims to evaluate and compare the analgesic efficacy of the Intertransverse Process Block (ITP) and the Erector Spinae Plane (ESP) block in patients undergoing Robotic Colorectal Surgery. The primary outcome is the Visual Analog Scale (VAS) score within the first 24 hours after surgery. Secondary outcomes include total opioid consumption, requirement for rescue analgesia, block-related and systemic side effects (hematoma, pneumothorax, local anesthetic systemic complications, vascular puncture, and infection), patient and surgeon satisfaction assessed using a Likert scale, and quality of recovery assessed using the QoR-15 questionnaire, and incedence of postoperative nausea and vomiting.
Patients aged 18-65 years
ASA physical status I-III
Scheduled for elective robotic colorectal surgery
Body mass index (BMI) between 18 and 35 kg/m²
Refusal to participate
Allergy to local anesthetics
Infection at the injection site
Coagulopathy or ongoing anticoagulant therapy
Parallel
Intertransverse Process Block (ITP)
Procedure/SurgeryIntertransverse Process Block (ITP) block will be performed 30 minutes prior to surgery with the patient in a sitting position. After skin disinfection with chlorhexidine, the skin and subcutaneous tissues will be anesthetized using 2-4 mL of 1% lidocaine. A linear ultrasound probe will be positioned along the medial border of spinous processs level of the 10th thoracic vertebrae. Anatomical landmarks, including the erector spinae muscle, transverse processes, and superior costotransverse ligament complex at the T10 level, will be identified. Upon confirmation and negative aspiration, 20 mL of 0.25% bupivacaine hydrochloride will be administered on each side under ultrasound guidance.
The Erector Spinae Plane Block (ESP)
Procedure/SurgeryThe Erector Spinae Plane Block (ESP) will be performed 30 minutes prior to surgery with the patient in a sitting position. After skin disinfection with chlorhexidine, the skin and subcutaneous tissues will be anesthetized using 2-4 mL of 1% lidocaine. A linear ultrasound probe will be positioned along the medial border of spinous processs level of the 10th thoracic vertebrae. Anatomical landmarks, including the trapezius muscle, rhomboid major muscle (RMM), erector spinal muscle and transverse processes of the 10th thoracic vertebrae will be identified. Proper needle placement will be confirmed with the injection of 1-2 mL isotonic saline. Upon confirmation and negative aspiration, 20 mL of 0.25% bupivacaine hydrochloride will be administered.
postoperative pain intensity (VAS score)
Postoperative pain will be assessed using the visual analog scale (VAS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores represent greater pain intensity. Measurements will be recorded at predefined time points within the first 24 hours after surgery.
Total opioid consumption via patient-controlled analgesia (PCA)
Requirement for rescue analgesia
Block-related and systemic side effects
Patient satisfaction assessed using a Likert scale
Patient satisfaction will be assessed using Likert scala (1 =very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, 5 = very satisfied). Higher scores indicate greater satisfaction.
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