Ultrasound-Guided External Oblique Intercostal Plane Block Versus Subcostal Transversus Abdominis Plane Block For Perioperative Analgesia in Laparoscopic Sleeve Gastrectomy

This study aims to compare the analgesic efficacy, duration of analgesia, and overall opioid consumption between the external oblique intercostal plane (EOIP) block and subcostal transversus abdominis plane (TAP) block in patients undergoing laparoscopic sleeve gastrectomy.

Study Overview

• Status: Recruiting
• Conditions: Ultrasound; Laparoscopic Sleeve Gastrectomy; Perioperative Analgesia; Subcostal Transversus Abdominis Plane Block; External Oblique Intercostal Plane Block
• Intervention / Treatment: Other: External oblique intercostal plane block; Other: Subcostal transversus abdominis plane block

Detailed Description

Postoperative pain management is a critical aspect of enhanced recovery after surgery (ERAS) protocols, particularly in laparoscopic bariatric procedures such as sleeve gastrectomy.

Among the ultrasound-guided abdominal wall blocks, the transversus abdominis plane (TAP) block and its subcostal variant have demonstrated efficacy for upper abdominal surgeries. The subcostal TAP block provides analgesia for the T6-T9 dermatomes, covering incisions in upper abdominal procedures like laparoscopic cholecystectomy and bariatric surgery.

The external oblique intercostal plane (EOIP) block is a relatively new fascial plane block that targets the intercostal nerves lying between the external oblique and intercostal muscles.

• Study Type: Interventional
• Enrollment (Estimated): 70
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ahmed A Ali, MBBCH; Phone Number: 00201067850909; Email: macisosevo@gmail.com

Study Locations

• Egypt
  • Benha
    • Banhā, Benha, Egypt, 13518
      • Recruiting
      • Benha University
      • Contact: Ahmed A Ali, MBBCH; Phone Number: 00201067850909; Email: macisosevo@gmail.com
      • Sub-Investigator: El sayed M Abd Elazeem, MD
      • Sub-Investigator: Fatma A Abd Elfataah, MD
      • Sub-Investigator: Zienab M Abd Elwahab, MD

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Age from 18 to 65 years.
• Both genders.
• American Society of Anesthesiologists (ASA) class I or II
• Body mass index (BMI) between 30-50 kg/m².
• Scheduled for elective laparoscopic sleeve gastrectomy under general anesthesia.
• Written informed consent from patients or surrogate decision makers.

Exclusion Criteria:

• Patient refusal.
• Allergy to local anesthetics.
• Coagulation disorders or anticoagulant therapy.
• Local infection or scar at the injection site.
• Severe hepatic or renal dysfunction.
• Chronic opioid use or psychiatric illness interfering with pain assessment.
• Conversion to open surgery or intraoperative complications requiring re-exploration.

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
Experimental: EOIP Group (Group A ); Patients will receive an ultrasound-guided bilateral external oblique intercostal plane (EOIP) block using 20 mL of 0.25% bupivacaine in each side after induction of anesthesia and prior to surgical incision.	Other: External oblique intercostal plane block; Patients will receive an ultrasound-guided bilateral external oblique intercostal plane (EOIP) block using 20 mL of 0.25% bupivacaine in each side after induction of anesthesia and prior to surgical incision.
Experimental: Subcostal TAP Group (Group T); Patients will receive a bilateral subcostal transversus abdominis plane (TAP) block using 20 mL of 0.25% bupivacaine in each side, under ultrasound guidance and identical conditions.	Other: Subcostal transversus abdominis plane block; Patients will receive a bilateral subcostal transversus abdominis plane (TAP) block using 20 mL of 0.25% bupivacaine in each side, under ultrasound guidance and identical conditions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total morphine consumption	Patient-controlled analgesia (PCA) using intravenous morphine (1 mg bolus, 10-minute lockout) will be available for rescue analgesia when visual analogue score ( VAS ) > 3.	24 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to first rescue analgesia	Time to first rescue analgesia will be recorded from the end of surgery till first dose of morphine administrated.	24 hours postoperatively
Degree of pain	Each patient will be instructed about postoperative pain assessment with the visual analogue score (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS will be recorded at 0, 2, 6, 12, and 24 hours postoperatively (at rest and cough).	24 hours postoperatively
Heart rate	Heart rate will be recorded intraoperatively and postoperatively	Till the end of surgery (Up to two hours)
Mean arterial blood pressure	Mean arterial blood pressure will be recorded intraoperatively and postoperatively	Till the end of surgery (Up to two hours)
Incidence of postoperative nausea and vomiting	Incidence of postoperative nausea and vomiting (PONV) will be recorded.	24 hours postoperatively
Block-related complications	Block-related complications such as pleural puncture, local anesthetic toxicity, and hematoma will be recorded.	24 hours postoperatively
Degree of patient satisfaction	Patient satisfaction will be assessed using a 5-point Likert scale at 24 hours (1 = very dissatisfied , 2 = dissatisfied, 3 =mild, 4= moderate satisfaction, 5 = very satisfied ).	24 hours postoperatively

Collaborators and Investigators

• Sponsor: Benha University

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2025
• Primary Completion (Estimated): November 1, 2026
• Study Completion (Estimated): November 1, 2026

Study Registration Dates

• First Submitted: January 17, 2026
• First Submitted That Met QC Criteria: January 17, 2026
• First Posted (Actual): January 26, 2026

Study Record Updates

• Last Update Posted (Actual): January 26, 2026
• Last Update Submitted That Met QC Criteria: January 17, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: MS.28.12.2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The data will be available upon a reasonable request from the corresponding author after the end of study for one year.
• IPD Sharing Time Frame: After the end of study for one year.
• IPD Sharing Access Criteria: The data will be available upon a reasonable request from the corresponding author.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

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