Perioperative Opioid-sparing Effect of Retrosuperior Costotransverse Ligament Block Versus Erector Spinae Block in Laparoscopic Cholecystectomy

Perioperative Opioid-sparing Effect of Retrosuperior Costotransverse Ligament Block Versus Erector Spinae Block in Laparoscopic Cholecystectomy: A Randomized Clinical Trial.

This study aims to compare the analgesic effect of retro superior costotransverse ligament space block vs erector spinae plane block to Achieve high-quality perioperative opioid-sparing effect and postoperative analgesia after laparoscopic cholecystectomy with optimum hemodynamic stability and high patient and surgeon satisfaction

Study Overview

• Status: Recruiting
• Conditions: Perioperative Analgesia
• Intervention / Treatment: Procedure: Retrosuperior costotransverse ligament block group; Procedure: Erector spinae block group

Detailed Description

This study aims to compare between retro superior costotransverse ligament space block vs erector spinae plane block

• To compare the analgesic outcomes (time to first analgesic request, total amount of analgesic consumption and pain scores by NRS)
• To assess the block performance time required to perform each technique .
• To compare intraoperative parameters (hemodynamics and intraoperative fentanyl consumption)
• To assess patient, surgeon satisfaction and complications of the block.

• Study Type: Interventional
• Enrollment (Estimated): 80
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Dina Salem, MD; Phone Number: 002 01099333513
• Study Contact Backup: Name: Marwa Medhat, MD; Phone Number: 002 01002828937

Study Locations

• Egypt
  • Zagazig, Egypt
    • Recruiting
    • Faculty of human medicine, Zagazig university, Zagazig
    • Contact: Dina Salem, MD; Phone Number: 002 01099333513; Email: dinamaghraby@yahoo.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. patient acceptance
2. Age: 21-64 years old.
3. Sex: both sexes.
4. Physical status: ASA I & II.
5. Body mass index (BMI): 18.5 - 30 kg/m2.
6. Type of operations: elective laparoscopic cholecystectomy.
7. Duration of surgery not more than 2 hours.

Exclusion Criteria:

1. Known hypersensitivity to lidocaine or bupivacaine.
2. Patients with respiratory insufficiency.
3. Coagulation disorders or taking drugs affect surgical hemostasis.

7. Patients with pre-existing neurological deficits. 8. Uncooperative patient or with altered mental status. 9. Patient with advanced cardiovascular or respiratory diseases

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Retrosuperior costotransverse ligament block group; The patient will receive retrosuperior costotransverse ligament block	Procedure: Retrosuperior costotransverse ligament block group; The patient will receive retrosuperior costotransverse ligament block
Active Comparator: Erector spinae block group; The patient will receive erector spinae block.	Procedure: Erector spinae block group; The patient will receive erector spinae block.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The time to first call to rescue analgesia	The time to first call to rescue analgesia( the interval between the block injection till the NRS more than or equal 4) (naluphine) will be recorded	24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To assess block characteristics (block performance time)	To assess block characteristics (block performance time) in minutes	1 hour
Total intraoperative fentanyl consumption	Total intraoperative fentanyl required other than the induction dose in micrograms	duration of surgery (up to 2 hours)
Pain intensity by Numerical Rating Scale	Analgesic parameters (Pain intensity at rest and at movement) by using Numerical Rating Scale (NRS) which will explained to patient as follows:0=no pain and 10= worst pain	30 minutes after arrival to post anesthesia care unit , 2hours, 4hours, 6hours, 8hours, 12hours, 18 hours and 24hours postoperative
total amount of rescue analgesia	total amount of rescue analgesia if NRS≥4. in the first 24 hours.	24 hours
Intraoperative hemodynamics (Heart Rate and Mean Arterial Pressure)	Intraoperative hemodynamics every 5 minutes in the first 30 minutes then every 10 minutes till the end of surgery	every 5 minutes in the first 30 minutes then every 10 minutes till the end of surgery
Patient's satisfaction	all patient's satisfaction: The patients will be asked to rate the overall degree of satisfaction of the analgesia by using a 5-points likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia)	24 hours
complication of the block	complication of the block( heamatoma,local anesthetic toxicity,infection)	24 hours

Collaborators and Investigators

• Sponsor: Zagazig University

Study record dates

Study Major Dates

• Study Start (Actual): December 10, 2025
• Primary Completion (Estimated): June 10, 2026
• Study Completion (Estimated): July 10, 2026

Study Registration Dates

• First Submitted: November 29, 2025
• First Submitted That Met QC Criteria: November 29, 2025
• First Posted (Estimated): December 11, 2025

Study Record Updates

• Last Update Posted (Actual): December 12, 2025
• Last Update Submitted That Met QC Criteria: December 11, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: laparoscopic cholecystectomy; erector spinae block; retrosuperior costotransverse ligament block
• Other Study ID Numbers: 1783

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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