RLB vs ERSP for Postoperative Analgesia in Lap Cholecystectomy

N/ANot Yet RecruitingNCT07598162

Sohag University100 enrolled

Overview

This prospective, randomized, double-blind clinical trial evaluates the comparative effectiveness of ultrasound-guided retrolaminar block (RLB) and erector spinae plane block (ESPB) for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. A total of 100 ASA I-II patients, aged 20-60 years, will be randomly allocated into two equal groups to receive either RLB or ESPB bilaterally following induction of standardized general anesthesia. The primary outcome is the time to first request for rescue analgesia, while secondary outcomes include total morphine consumption within the first 24 hours, postoperative pain scores assessed using the Numeric Rating Scale (NRS), patient satisfaction, and the incidence of adverse events. Pain assessment will be performed at predefined intervals over the first 24 hours postoperatively. The study aims to determine which technique provides superior analgesia with reduced opioid requirements and improved patient outcomes.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

100

Conditions

Laparoscopic Cholecystectomy Surgery Postoperative Analgesia

Interventions

Patients will be positioned laterally, and a curved ultrasound probe will be aligned longitudinally at the T7 vertebra. The vertebral lamina and spinous process will be identified. A needle will be inserted 1 - 1.5 cm lateral to the spinous process, advanced toward the lamina, and 20 mL of LA mixture will be injected into the fascial plane between the lamina and transversus spinae muscles bilaterally.

Erector spinae plane block (ESPB)PROCEDURE

The blocks will be conducted at the level of the T7 spinous process (SP) with the patient in the lateral position and the arm abducted. Using US ( curved probe ) , the T7 transverse process (TP) is identified by counting from the 12th rib. The US probe is positioned 2 - 3 cm laterally to the SP of T7 and situated over the TP of T7/T8 in the parasagittal longitudinal plane, with the erector spinae muscle (ESM) visualized over the TP. The needle is then inserted and advanced in plane from cephalad to caudad until the needle tip contacts the TP of T7. Following hydro dissection with 2 mL of isotonic saline, which elevates the ESM, 20 mL of LA mixture is administered after several negative aspirations.

Eligibility

Sex: ALLMin age: 20 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * • Age from 20 to 60 years. * Both sexes. * American Society of Anesthesiology (ASA) grade I and II physical status. * Patients will undergo cholecystectomy under general anesthesia. Exclusion Criteria: * • Sensitivities or contraindications to the study medications. * Infection at the site of injection. * Emergency surgery. * Body mass index (BMI) \> 35. * Organic comorbidities. * Histories of psychological conditions and/or chronic pain syndromes. * Contraindications to regional anesthesia. * Severe respiratory, cardiac, hepatic and renal disorders. * Pregnancy. * Coagulopathy. * Opioid addiction.

Outcomes

Primary Outcomes

Time to the 1st rescue analgesia

Time frame: in the 1st 24hr.

Secondary Outcomes

Total morphine consumption

Time frame: in the 1st 24hr.

Pain score.

postoperative pain assessment with the Numeric Rating Scale (NRS). Numeric rating scale .. zero represents no pain while 10 represents the worst pain imaginable

Time frame: Pain will be assessed at, 2, 4, 6, 8, 12, 18 and 24 hour postoperatively.

Degree of patient satisfaction

• Degree of patient satisfaction will be assessed on a 5-point Likert scale patient satisfaction (1 represents extremely dissatisfied 2 represesnts unsatisfied; 3 represents neutral 4 represents satisfied 5 represents extremely satisfied)

Time frame: in the first 24 hours after surgery