Rhomboid Intercostal Block Versus Retrolaminar Block for Postoperative Analgesia After Thoracoscopic Sympathectomy

Ultrasound-guided Rhomboid Intercostal Block Versus Retrolaminar Block for Postoperative Analgesia After Thoracoscopic Sympathectomy: A Randomized Clinical Trial

Background: Although thoracoscopic sympathectomy is made via small incisions, it is associated with severe postoperative pain. Both Rhomboid intercostal block (RIB) and Retrolaminar block (RLB) are recent techniques used for pain control after such procedures

Objectives: To compare the effectiveness of RIB and RLB in providing postoperative analgesia after thoracoscopic sympathectomy in adult patients and their impact on the patient's outcomes.

Patients and Methods: This prospective, randomized (1:1), double-blind clinical trial; will be carried out on 60 patients scheduled for elective thoracoscopic sympathectomy under general anesthesia at our hospital. Patients will be randomly allocated into two equal groups (30 patients each) and will receive: in group A; general anesthesia with intraoperative ipsilateral ultrasound-guided RIB, whereas in group B; general anesthesia with intraoperative ipsilateral ultrasound-guided RLB.

Study Overview

• Status: Recruiting
• Conditions: Post Operative Pain
• Intervention / Treatment: Procedure: Rhomboid Intercostal Block (RIB); Procedure: Retrolaminar Block (RLB)

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ahmed M Shaat, MD; Phone Number: 00201223482709; Email: ahmedshaat99@gmail.com

Study Locations

• Egypt
  • El-Beheira
    • Damanhūr, El-Beheira, Egypt
      • Recruiting
      • Damanhour Teaching Hospital
      • Contact: Ahmed M Shaat, MD; Phone Number: 00201223482709; Email: ahmedshaat99@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• American Society of Anesthesiologists (ASA) physical status ≤ II
• Age from 18 to 60 years
• Body Mass Index (BMI) < 35 kg/m²

Exclusion Criteria:

• American Society of Anesthesiologists (ASA) physical status > II
• Age < 18 years or > 60 years
• Body Mass Index (BMI) ≥ 35
• Local infection at the puncture site
• Altered mental status
• Pregnant women
• Allergy to study drugs
• Chronic pain
• Coagulation abnormalities or on anticoagulants
• Severe hepatic or kidney disease

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Group A (n=30); Rhomboid Intercostal Block	Procedure: Rhomboid Intercostal Block (RIB); Intraoperative Ipsilateral Ultrasound-guided RIB
Active Comparator: Group B (n=30); Retrolaminar Block	Procedure: Retrolaminar Block (RLB); Intraoperative Ipsilateral Ultrasound-guided RLB

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean and Standard deviation of time to the first request of postoperative rescue analgesic (minutes) (mean±SD)	The time interval between the block performance and the first request of postoperative analgesia	24 hours after the end of surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean and Standard deviation of Numeric Pain Rating Scale (NPRS) score (mean±SD)	NPRS measures the severity of postoperative pain, it is a 11 point scale from 0-10; where 0=No pain and 10=Worst possible pain (At PACU, 1h, 3h, 6h, 12h, 18h, 24h) after the end of surgery	24 hours after the end of surgery
Mean and Standard deviation of the total dose of the rescue analgesic consumed (milligrams) (mean±SD)	The total dose of the rescue analgesic consumed in the first 24 hours after the end of surgery	24 hours after the end of surgery

Collaborators and Investigators

• Sponsor: Damanhour Teaching Hospital
• Investigators: Principal Investigator: Ahmed M Shaat, MD, Damanhour Teaching Hospital

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2025
• Primary Completion (Estimated): January 1, 2026
• Study Completion (Estimated): January 30, 2026

Study Registration Dates

• First Submitted: October 21, 2024
• First Submitted That Met QC Criteria: October 21, 2024
• First Posted (Actual): October 22, 2024

Study Record Updates

• Last Update Posted (Actual): August 21, 2025
• Last Update Submitted That Met QC Criteria: August 20, 2025
• Last Verified: July 1, 2025

More Information

Terms related to this study

• Keywords: Regional Analgesia; Rhomboid Intercostal Block; Retrolaminar Block
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pain, Postoperative
• Other Study ID Numbers: DTH: 24001

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No