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Erector Spinae Plane Block Versus Subcostal Transversus Abdominis Plane Block Under Skin Conductance Algesimeter Guidance in Laparoscopic Gynecologic Oncologic Surgery

4. november 2026 opdateret af: Savas Altinsoy, Diskapi Yildirim Beyazit Education and Research Hospital

Comparison of the Analgesic Efficacy of Bilateral Subcostal Transversus Abdominis Plane Block and Bilateral Erector Spinae Plane Block Guided by Skin Conductance Algesimeter Pain Monitoring in Laparoscopic Gynecologic Oncologic Surgery: A Prospective Randomized Study

This prospective randomized study compared two ultrasound-guided regional anesthesia techniques used as part of multimodal analgesia in women undergoing elective laparoscopic gynecologic oncologic surgery: bilateral erector spinae plane (ESP) block and bilateral subcostal transversus abdominis plane (TAP) block. During general anesthesia, the remifentanil infusion was titrated according to the skin conductance algesimeter (SCA), a device that monitors the sympathetic response to noxious stimuli. The main question was whether ESP block reduces intraoperative remifentanil consumption compared with subcostal TAP block. Postoperative pain scores, rescue analgesic requirement, and quality of recovery were also compared during the first 24 postoperative hours.

Studieoversigt

Status

Ikke rekrutterer endnu

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Female patients aged 18-65 years with ASA physical status I-III scheduled for elective laparoscopic gynecologic oncologic surgery were randomized in a 1:1 ratio using a computer-generated list (Research Randomizer) to the ESP group or the subcostal TAP group. General anesthesia was induced with fentanyl 0.5 µg/kg, propofol 2.5 mg/kg, and rocuronium 0.6 mg/kg and maintained with sevoflurane at approximately 1 minimum alveolar concentration. After induction and before surgical incision, blocks were performed under ultrasound guidance by experienced anesthesiologists with 20 mL of 0.25% bupivacaine on each side (total 40 mL): bilateral ESP block at the T9 level in the lateral decubitus position, or bilateral subcostal TAP block at the midclavicular line below the costal margin in the supine position.

Remifentanil infusion was started at 0.05-0.2 µg/kg/min and titrated according to the SCA index: decreased by 0.025 µg/kg/min when the index was 0-1, maintained when it was 3, and increased by 0.025-0.05 µg/kg/min when it was above 3, with at least 5 minutes between dose changes. The infusion could be reduced to zero when the SCA index remained at 0-1. Heart rate, blood pressure, SCA index, and bispectral index (BIS) were recorded at baseline, after intubation, every 15 minutes during surgery, and before and after extubation. All patients received intravenous dexketoprofen 50 mg and paracetamol 1 g approximately 30 minutes before the end of surgery.

Postoperative pain was assessed with the Numeric Rating Scale (NRS) at 0, 2, 4, 6, 12, 18, and 24 hours. Tenoxicam was given for NRS ≥4 and tramadol for NRS ≥7 as rescue analgesics. The Quality of Recovery-15 (QoR-15) questionnaire was administered preoperatively and at 24 hours postoperatively. Intraoperative data and postoperative follow-up were recorded by investigators who did not perform the blocks.

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

66

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år til 65 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Kvinde

Beskrivelse

Inclusion Criteria:

Women aged 18-65 years Scheduled for elective laparoscopic gynecologic oncologic surgery ASA physical status I-III Body mass index 18-40 kg/m² Written informed consent No contraindication to regional block

Exclusion Criteria:

Age <18 or >65 years ASA physical status IV or higher Severe systemic comorbidity Known allergy to local anesthetics Bleeding diathesis or coagulopathy Infection at the block site Body mass index <18 or >40 kg/m² Emergency surgery

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Andet
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Enkelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Andet: ESP Group

Bilateral ultrasound-guided erector spinae plane block at the T9 level with 20 mL of 0.25% bupivacaine on each side, performed after induction of general anesthesia and before surgical incision. Intraoperative remifentanil infusion titrated according to the skin conductance algesimeter index.

Procedure: Erector spinae plane block - Ultrasound-guided bilateral ESP block at T9 with 20 mL of 0.25% bupivacaine per side. Arm: ESP Group.

Andet: Subcostal TAP Group

Bilateral ultrasound-guided subcostal transversus abdominis plane block with 20 mL of 0.25% bupivacaine on each side, performed after induction of general anesthesia and before surgical incision. Intraoperative remifentanil infusion titrated according to the skin conductance algesimeter index.

Procedure: Subcostal transversus abdominis plane block - Ultrasound-guided bilateral subcostal TAP block at the midclavicular line with 20 mL of 0.25% bupivacaine per side. Arm: Subcostal TAP Group.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Total intraoperative remifentanil consumption
Tidsramme: from induction of anesthesia to the end of surgery.

Total intraoperative remifentanil consumption - Total amount of remifentanil (µg) administered under skin conductance algesimeter guidance.

from induction of anesthesia to the end of surgery.

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Time to first rescue analgesic
Tidsramme: 0, 2, 4, 6, 12, 18, and 24 hours postoperatively.

Time to first rescue analgesic - Time from extubation to the first rescue analgesic administration (minutes). Time frame: first 24 postoperative hours.

0, 2, 4, 6, 12, 18, and 24 hours postoperatively.
Rescue analgesic requirement
Tidsramme: 0, 2, 4, 6, 12, 18, and 24 hours postoperatively.

Rescue analgesic requirement - Number of patients receiving rescue analgesics (tenoxicam or tramadol). 0, 2, 4, 6, 12, 18, and 24 hours postoperatively.

0, 2, 4, 6, 12, 18, and 24 hours postoperatively.
Postoperative pain scores
Tidsramme: 0, 2, 4, 6, 12, 18, and 24 hours postoperatively.

Postoperative pain scores - Numeric Rating Scale (0 = no pain, 10 = worst imaginable pain).

0, 2, 4, 6, 12, 18, and 24 hours postoperatively.
Quality of recovery
Tidsramme: Time frame: preoperatively and 24 hours postoperatively.

Quality of recovery - Quality of Recovery-15 (QoR-15) score (0-150; higher scores indicate better recovery).

Time frame: preoperatively and 24 hours postoperatively.

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Efterforskere

  • Ledende efterforsker: Savaş Altınsoy, Ankara Etlik City Hospital

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Anslået)

15. november 2026

Primær færdiggørelse (Anslået)

15. februar 2027

Studieafslutning (Anslået)

15. marts 2027

Datoer for studieregistrering

Først indsendt

4. november 2026

Først indsendt, der opfyldte QC-kriterier

4. november 2026

Først opslået (Faktiske)

10. november 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

10. november 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

4. november 2026

Sidst verificeret

1. november 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

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