Comparison of Serratus Intercostal Plane Blcok With Erector Spinae Plane Block for Open Nephrectomy
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18-65
SponsorFayoum University Hospital
About this trial
Effective postoperative pain management following open nephrectomy remains a significant clinical challenge.
Inadequate pain control after this procedure may lead to impaired respiratory function, delayed mobilization, prolonged hospital stay, increased opioid consumption, and a higher incidence of postoperative complications. Therefore, optimizing postoperative analgesia while minimizing opioid-related adverse effects is a key objective in perioperative care for patients undergoing open nephrectomy Traditionally, postoperative pain following open nephrectomy has been managed using systemic opioids, epidural analgesia, or paravertebral blocks.
Ultrasound-guided fascial plane blocks have emerged as valuable alternatives in modern regional anesthesia due to their simplicity, safety profile, and effectiveness. Among these techniques, the erector spinae plane (ESP) block has gained widespread popularity.
This block has been shown to provide effective analgesia for thoracic, abdominal, and urologic surgeries, including nephrectomy The ultrasound-guided serratus intercostal plane block (SIPB) is a more recently described regional anesthetic technique targeting the lateral cutaneous branches of the intercostal nerves by injecting local anesthetic between the serratus anterior muscle and the intercostal muscles or ribs By blocking these nerves, SIPB provides analgesia to the lateral thoracic wall and upper abdominal regions, which are particularly relevant to flank incisions used in open nephrectomy.
Patients will be randomly allocated into two equal groups. Patients in group (S) will receive serratus intercostal plane block and those in group (E) will receive Erector spinae plane block . Both of these blocks will be performed after induction of general anaesthesia by an experienced anaesthesiologist The aim of this study is to to compare the analgesic efficacy of ultrasound-guided serratus intercostal plane block and erector spinae plane block in patients undergoing open nephrectomy.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Patients scheduled for elective open nephrectomy under general anesthesia via flank incision .
Adult patients aged 18-65 years.
Patients with an American Society of Anesthesiologists (ASA) physical status I to III.
Disqualifiers
Patient refusal.
Allergy to local anesthetics and patient with infection at the injection site of block.
Coagulation disorders or ongoing anticoagulant therapy.
Patients receiving opioids for chronic analgesic therapy (cancer, addiction).
Trial design
Design model
Parallel
Treatments tested in this trial
Serratus Intercostal Plane Block
Procedure/SurgeryBlock will be performed in the operating room, With the patient in the supine decubitus position, aseptic conditions were provided for the block, The high-frequency linear transducer of ultrasound (LOGIQ P7) will be placed in the mid-axillary line at the level of the eighths rib. The serratus anterior muscle and underlying intercostal muscles will be identified. A 22-gauge, 50 mm echogenic needle (Stimuplex D; B Braun, Germany) will be advanced in plane in the caudo-cranial direction. After negative aspiration, 25 mL of 0.25% bupivacaine HCl (plain)will be injected between the serratus anterior muscle and the intercostal muscles.
Erector Spinae Plane Block
Procedure/SurgeryBlock will be performed in the operating room, With the patient in the lateral decubitus position, Aseptic conditions were provided for the block, The high-frequency linear transducer of ultrasound (LOGIQ P7) will be placed parasagittally at the level of the T8-T10 transverse process. The erector spinae muscle and transverse process will be identified. A 22-gauge, 50 mm echogenic needle (Stimuplex D; B Braun, Germany) will be advanced in plane in the cranio-caudal direction and after negative aspiration, 25 mL of 0.25% bupivacaine HCl (plain) will be injected deep to the erector spinae muscle.
Treatment groups
132 Participants
are divided into 2 treatment groupsGroup A: Group (S) Serratus Intercostal Plane Block:Experimental treatment 1 intervention
Group B: Group (E) Erector Spinae Plane Block:Experimental treatment 1 intervention
Trial outcomes
Primary outcomes
1
• Postoperative pain score at rest 12 hours after surgery measured using the 0-10 Visual Analogue Scale (VAS).
VAS pain score (0-10 cm) (where 0=no pain and 10 = worst pain imaginable).
Time frame
12 hours post-surgerySecondary outcomes
1
• Postoperative pain intensity assessed using the VAS at rest and during deep inspiration at the immediate postoperative period, 2, and 6 hours postoperatively.
VAS pain score (0-10 cm) (where 0=no pain and 10 = worst pain imaginable).
Time frame
0, 2, and 6 hours after surgery completion2
• Postoperative pain intensity assessed using the visual analogue scale (VAS) during deep inspiration at 12 hours postoperatively
VAS pain score (0-10 cm) (where 0=no pain and 10 = worst pain imaginable). during deep expiration
Time frame
12 hours post-surgery3
• Block success rate (dermatomal sensory loss)
After recovery from anesthesia (PACU): Cold sensation test using alcohol swab at T7-T12 dermatomes. Block considered successful if ≥3 dermatomes sensory loss within 30 min. Failed blocks will be recorded and analyzed
Time frame
30 minutes After arrival in Post-Anaesthesia Care Unit (PACU)4
• Cumulative morphine consumption in 24 hours (in mg).
• Rescue analgesia will be administered via intravenous morphine using a PCA pump programmed to deliver 1 mg per demand with a 10-minute lockout interval and no basal infusion. Cumulative 24-hour morphine consumption will be recorded
Time frame
From surgery completion up to 24 hours post-surgerySponsors and contacts
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Source ClinicalTrials.gov