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Pain ManagementNCT06241794

The Efficacy of Thoracoabdominal Nerve Block With Serratus Intercostal Plane and Rectus Sheath Block in Cholecystectomy

A study testing Group M-TAPA and Group Serratus Intercostal Plane Block and Rectus Sheath Block in people with Pain Management, run by Hitit University at 1 site in Turkey (Türkiye).

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Cholecystectomy is a widespread surgical procedure performed worldwide for acute cholecystitis. This operation can be performed using open surgery or laparoscopic techniques. Laparoscopic technique is superior to open surgery in terms of less pain at incision sites, shorter hospital stay, improved quality of life, and… Read more about this study

Who is it for?
Ages 18 to 65 years
Conditions the study is for
Pain Management
What is being tested?
Group M-TAPA and Group Serratus Intercostal Plane Block and Rectus Sheath Block
Could I receive a placebo?
No, everyone receives an active treatment
How many people
72 participants
Where
1 siteTurkey (Türkiye)
Study dates
5 Feb 2024to 7 Aug 2024
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • American Society of Anesthesiologists (ASA) classification with physical status 1-2
  • Between the ages of 18 and 65
  • Body Mass Index (BMI) <35
  • Has read and accepted the informed consent form voluntarily

Who cannot join

  • The patient's unwillingness to participate in the study
  • Patients with a body mass index (BMI) >35
  • ASA 3-5 classification
  • unable to use the NRS pain scoring system
  • allergies to the used local anesthetic and specified analgesic drugs
  • individuals declaring pregnancy or breastfeeding
Show all 20Show fewer
  • patients under 18 or over 65 years of age
  • those with uncontrolled anxiety
  • alcohol and drug addiction
  • neuromuscular and peripheral nerve diseases
  • using high-dose opioid drugs three days before surgery
  • hepatic and renal insufficiency, coagulation disorders
  • diabetes mellitus
  • patients using anticoagulant drugs
  • infections at the site of peripheral block needle entry
  • those undergoing a second procedure along with laparoscopic cholecystectomy
  • individuals with a history of abdominal surgery or trauma
  • conversion of laparoscopic surgery to open surgery
  • inability to communicate in Turkish
  • NRS score above 7 for consecutive 4 hours despite the planned multimodal analgesia regimen

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site
  • Hitit University Erol Olcok Training and Research Hospital

    Çorum, Center, 19040

Other trials in Turkey (Türkiye)

About this study

Official title: Comparison of Postoperative Analgesic Efficacy of Perichondrial Approach Modified Thoracoabdominal Nerve Block and the Combination of Serratus Intercostal Plane and Rectus Sheath Block Via to Patients Who Underwent Cholecystectomy

Cholecystectomy is a widespread surgical procedure performed worldwide for acute cholecystitis. This operation can be performed using open surgery or laparoscopic techniques. Laparoscopic technique is superior to open surgery in terms of less pain at incision sites, shorter hospital stay, improved quality of life, and faster recovery times.However, despite being a minimally invasive surgery, laparoscopic cholecystectomy (LC) can still cause moderate to severe pain. Severe pain can lead to delayed postoperative ambulation, decreased patient satisfaction, the development of chronic pain, and is associated with increased lung and heart complications. Postoperative pain in LC can stem from various causes. To reduce the postoperative pain caused by LC, non-steroidal anti-inflammatory drugs, paracetamol, opioids, local anesthetics, and various regional anesthesia techniques are used.Multimodal analgesia has shown that the use of regional anesthesia and analgesia is crucial in reducing the neuroendocrine stress response in pain and trauma situations. The use of interfascial plane blocks performed under ultrasound guidance in LC surgery, considered easy and safe, has increased in recent years. The thoracoabdominal plane block (TAPA) applied through a perichondrial approach reaches a broader dermatomal area than the transversus abdominis plane (TAP) block and the oblique subcostal transversus abdominis plane (OSTAP) block.Serratus intercostal plane block (SIPB) has been found effective for somatic analgesia in a case series after gastrectomy and cholecystectomy surgeries. Subsequent studies have indicated the effectiveness of SIPB for open upper abdominal surgeries. Rectus sheath block (RSB) is used to provide postoperative analgesia after various surgeries, including laparoscopic and upper abdominal surgeries. Ultrasound-guided RSB in LC has significantly reduced postoperative pain.In this study, similar to the combination of RSB and SIPB was planned to be applied to enhance the effectiveness and quality of analgesia in the mid-abdomen. A group in LC surgery was administered bilateral M-TAPA, while another group received bilateral RSB + right SIPB, aiming to compare the postoperative analgesic effectiveness.

Read the detailed description

The gallbladder is a small organ located in the right upper quadrant of the abdomen. Bile, which aids in the digestion of food, is collected in this organ. Gallstones are solid particles that form as a result of changes in the composition and concentration of bile caused by hormones, medications, diet, and weight changes. Sometimes, gallstones that form can block the normal flow of bile by exiting the gallbladder, leading to a condition known as acute cholecystitis when the cystic duct is obstructed by a gallstone. This condition causes distension and inflammation of the gallbladder.

Cholecystectomy is a common surgical procedure performed worldwide for acute cholecystitis. The management of acute cholecystitis is divided into medical and surgical approaches. Medical management includes bed rest, analgesic agents, antibiotic therapy, and intravenous fluid replacement. Surgical management involves a procedure called cholecystectomy, which is the surgical removal of the gallbladder. This operation can be performed using open surgery or laparoscopic techniques. The laparoscopic technique is superior to open surgery in terms of less pain at incision sites, shorter hospital stay, improved quality of life, and faster recovery times. However, laparoscopic cholecystectomy (LC), despite being a minimally invasive surgery, can still cause moderate to severe pain.

Severe pain can lead to delayed postoperative ambulation, decreased patient satisfaction, the development of chronic pain, and is associated with increased lung and heart complications. Postoperative pain in LC can arise from various causes. While a significant portion of postoperative pain in LC is attributed to incision sites (50-70%), it also originates from pneumoperitoneum (20-30%) and cholecystectomy (10-20%). Multimodal analgesia, including non-steroidal anti-inflammatory drugs, paracetamol, opioids, local anesthetics, and various regional anesthesia techniques, should be considered for pain control. Opioids may cause side effects such as postoperative nausea and vomiting (PONV), constipation, and respiratory depression. Neuraxial analgesia is rarely used in LC due to possible complications and technical difficulties.

The use of interfascial plane blocks under ultrasound guidance, considered easy and safe, has increased in LC surgery. The thoracoabdominal plane block (TAPA) applied through a perichondrial approach, showing that it spreads to a broader dermatomal area than the transversus abdominis plane (TAP) block and the oblique subcostal transversus abdominis plane (OSTAP) block. The rectus sheath block (RSB) is used to provide postoperative analgesia after various surgeries, including laparoscopic and upper abdominal surgeries. Ultrasound-guided RSB in LC has significantly reduced postoperative pain.

In this study, the combination of RSB and SIPB was planned to be applied to enhance the effectiveness and quality of analgesia in the mid-abdomen. Patients will be asked to fill out the Quality of Recovery-15 (QoR-15) scale, a self-report questionnaire used to assess the quality of postoperative recovery, in the preoperative waiting area on the morning of the surgery and 24 hours after the surgery. The QoR-15 scale measures recovery quality in five areas: physical comfort, pain, physical independence, psychological support, and emotional state, providing a one-dimensional measurement of recovery quality with scores ranging from 0 to 150. A higher score indicates better recovery quality.

In this study, in laparoscopic cholecystectomy, one group will receive bilateral M-TAPA, and another group will receive bilateral RSB + right SIPB to investigate their superiority in terms of postoperative NRS (Numeric Rating Scale) score, opioid consumption, dermatomal spread, PONV score, and complications, aiming to determine which is more effective.

Conditions
Pain Management
Being tested
Group M-TAPA, Group Serratus Intercostal Plane Block and Rectus Sheath Block
Keywords
Laparoscopic Cholecystectomy, Modified Thoracoabdominal Plane Block, Serratus Intercostal Plane Block, Rectus Sheath Block
Medical subject headings
Agnosia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Group M-TAPAProcedure or surgery

    Aseptic conditions are ensured in the area where the block will be performed. Under ultrasound guidance, a linear probe at the sagittal plane and costochondral angle is used to identify the transversus abdominis, internal oblique, and external oblique muscles at the level of the 10th rib. To visualize the lower surface of the rib cartilage in the midline, a sagittal angle is applied with the probe in the direction of the costochondral angle at the edge of the 10th rib. Using a 22-G, 80-100 mm block needle with an in-plane technique, the needle is advanced cranially. The needle tip is directed towards the posterior surface of the 10th rib cartilage, underneath the condyle. Subsequently, 20 ml of 0.25% concentration bupivacaine is injected beneath the condyle. The same procedure will be applied to the opposite side using the same technique.

  • Group Serratus Intercostal Plane Block and Rectus Sheath BlockProcedure or surgery

    Serratus intercostal plane block:The serratus anterior muscle and intercostal muscles are identified at the level of 8th rib along the right mid-axillary line.Using block needle,20 ml of 0.25% Bupivacaine is injected into the interfascial plane between these muscles.The SIPB will be performed only on the right side.

    Rectus sheath block:a linear probe is placed in a transverse position just above the umbilicus and slightly lateral to the midline.After visualizing the rectus abdominis muscle, posterior rectus sheath,and the hypoechoic space between them,block needle is advanced in-plane along the subcutaneous tissue.The needle is progressed until reaching the space between the epimysium of the muscle and the posterior rectus sheath, passing horizontally through the anterior rectus sheath of the rectus abdominis muscle.10 ml of 0.25% bupivacaine is injected.Adequate spread will lift the epimysium of rectus abdominis muscle while displacing the posterior fascia and peritoneum downward

Study groups in NCT06241794
Study groupRoleWhat they receive
Group M-TAPAActive comparatorM-TAPA: Aseptic conditions are ensured in the area where the block will be performed. Under ultrasound guidance, a linear probe at the sagittal plane and costochondral angle is used to identify the transversus abdominis, internal oblique, and external oblique muscles at the level of the 10th rib. To visualize the lower surface of the rib cartilage in the midline, a sagittal angle is applied with the probe in the direction of the costochondral angle at the edge of the 10th rib. Using a 22-G, 80-100 mm block needle with an in-plane technique, the needle is advanced cranially. The needle tip is directed towards the posterior surface of the 10th rib cartilage, underneath the condyle. Subsequently, 20 ml of 0.25% concentration bupivacaine is injected beneath the condyle. The same procedure will be applied to the opposite side using the same technique.
Receives: Procedure: Group M-TAPA
Group Serratus Intercostal Plane Block and Rectus Sheath BlockActive comparatorSerratus intercostal plane block:The serratus anterior muscle and intercostal muscles are identified at the level of 8th rib along the right mid-axillary line.Using block needle,20 ml of 0.25% Bupivacaine is injected into the interfascial plane between these muscles.The SIPB will be performed only on right side. Rectus sheath block:a linear probe is placed in a transverse position just above the umbilicus and slightly lateral to the midline.After visualizing the rectus abdominis muscle, posterior rectus sheath,and the hypoechoic space between them,block needle is advanced in-plane along the subcutaneous tissue.The needle is progressed until reaching the space between the epimysium of the muscle and the posterior rectus sheath, passing horizontally through the anterior rectus sheath of the rectus abdominis muscle.10 ml of 0.25% bupivacaine is injected.Adequate spread will lift the epimysium of the rectus abdominis muscle while displacing the posterior fascia and peritoneum downward
Receives: Procedure: Group Serratus Intercostal Plane Block and Rectus Sheath Block

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Postoperative Pain Examination

    Determination of patients' post-operative pain level. The Numeric Rating Scale (NRS), a method that converts the patient's pain perception into a numerical form, will be used to assess postoperative pain. NRS has a numerical scale ranging from 0 to 10. The patient will rate the intensity of pain on a scale from 0, indicating no pain, to 10, representing the worst imaginable pain (NRS 0=no pain, 4=mild to moderate pain, 6-8=severe pain, and >8=intolerable pain). The NRS score will be evaluated both at rest and during active movement situations (such as transitioning from a lying to a sitting position).

    The Numeric Rating Scale (NRS): (NRS 0=no pain, 4=mild to moderate pain, 6-8=severe pain, and >8=intolerable pain)

    Measured: 24 hour

Secondary outcomes (1)
  1. Opioid Consumption

    Total 24-hour tramadol consumption of patients in mg.

    Measured: 24 hour

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Feb 2024
  2. Study start5 Feb 2024
  3. Primary completion30 Apr 2024
  4. Study completion7 Aug 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
72 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06241794
Sponsor's protocol ID
2023-172
Status last verified
Feb 2025
First submitted
28 Jan 2024
Last updated
3 Mar 2025
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Group M-TAPA and Group Serratus Intercostal Plane Block and Rectus Sheath Block in people with Pain Management, run by Hitit University at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 20 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 3 Mar 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 3 Mar 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Postoperative Pain Examination (time frame: 24 hour). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Mar 2025.

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