EOI Block in Otoplasty With Rib Cartilage Graft

Seoul National University Hospital60 enrolled

Overview

This randomized controlled trial aims to evaluate the effect of ultrasound-guided external oblique intercostal (EOI) fascial plane block on postoperative pain control and recovery in pediatric patients undergoing otoplasty with rib cartilage graft under general anesthesia. Participants aged 13 to 18 years will be randomly assigned to receive either EOI block with 0.2% ropivacaine or no block. Primary outcome is total opioid consumption within 24 hours after surgery. Secondary outcomes include NRS pain scores, incentive spirometry performance, incidence of atelectasis, and patient satisfaction.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

TRIPLE

Enrollment

Conditions

Postoperative Pain, Acute

Interventions

Under general anesthesia, a linear ultrasound probe (6-13 MHz) is placed transversely at the 8th-9th intercostal space along the anterior axillary line. A 22-gauge, 50-80 mm needle is advanced in-plane into the fascial plane between the external oblique and intercostal muscles. After confirming correct needle placement, 0.2% ropivacaine 0.5 mL/kg (maximum 30 mL) is injected. The procedure is performed at the end of otoplasty with rib cartilage graft to provide postoperative analgesia.

Standard postoperative pain management (no EOI block)PROCEDURE

Participants will not receive the EOI block. All other perioperative management, including general anesthesia and postoperative intravenous patient-controlled analgesia (IV-PCA) with fentanyl, will be identical to the experimental group.

Eligibility

Sex: ALLMin age: 13 YearsMax age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * \- Pediatric patients aged 13 to 18 years undergoing otoplasty with rib cartilage graft under general anesthesia at Seoul National University Children's Hospital * Written informed consent obtained from parent or legal guardian, and assent from the patient Exclusion Criteria: * Unstable vital signs before surgery (heart rate \<50 or \>150 beats/min, systolic blood pressure \<80 mmHg or \>160 mmHg) * Known hypersensitivity to ropivacaine or other amide-type local anesthetics * Massive bleeding or shock * Local infection at the injection site * Sepsis * History of allergy to opioid medications * Severe renal dysfunction (creatinine \>3.0 mg/dL) * Severe hepatic dysfunction (AST or ALT \>120 U/L) * Any condition that, in the investigator's opinion, makes the subject unsuitable for study participation

Outcomes

Primary Outcomes

Total opioid consumption within 24 hours after surgery

Total amount of opioid analgesic (fentanyl) administered via intravenous patient-controlled analgesia (IV-PCA) and additional rescue doses within 24 hours postoperatively. The total dose will be normalized to body weight (µg/kg).

Time frame: Within 24 hours after surgery

Secondary Outcomes

Pain intensity at rest

Pain intensity at rest assessed using the Numerical Rating Scale (NRS, 0-10; higher scores = worse pain)