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Postoperative Pain ManagementITM-ESP-IPLANCT07203794

Analgesic Efficacy of Bupivacaine Infiltration, Erector Spinae Plane Block, and Intrathecal Morphine in Laparoscopic Cholecystectomy

A study testing Bupivacaine Infiltration, Erector Spinae Plane Block and Intrathecal Morphine in people with Postoperative Pain Management and Cholecystectomy, Laparoscopic, run by Ataturk University at 1 site in Turkey (Türkiye).

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

This study is designed to compare three different methods of pain control after laparoscopic gallbladder surgery (laparoscopic cholecystectomy). Although this surgery is minimally invasive, participants often experience different types of pain after the operation, such as pain at the incision site, pain inside the… Read more about this study

Who is it for?
Ages 18 to 65 years
What is being tested?
Bupivacaine Infiltration, Erector Spinae Plane Block and Intrathecal Morphine
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
132 participants
Where
1 siteTurkey (Türkiye)
Study dates
1 Dec 2025to 2 Apr 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

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

  • Adults aged 18-65 years
  • Scheduled for elective laparoscopic cholecystectomy
  • American Society of Anesthesiologists (ASA) physical status I-III
  • Able to provide written informed consent

Who cannot join

  • Body mass index (BMI) > 35 kg/m²
  • History of coagulopathy or bleeding disorders
  • Known allergy or hypersensitivity to opioids or local anesthetics
  • Chronic pain or regular analgesic use
  • History of neurological or psychiatric disease
  • Pregnancy
  • Refusal to participate in the study

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

İrem Ateş, Doçent Doctor contact

+90 532 740 12 58

driremates@hotmail.com

Mehmet Akif Yılmaz, assistant doctor contact

+90 534 653 35 39

mehmetakifyilmaz025@gmail.com

Turkey (Türkiye)1 site
  • Ataturk University

    Erzurum, 25000

    Mehmet Akif Yılmaz, assistant doctor, +90-534-653-35-39, mehmetakifyilmaz025@gmail.com

Other trials in Turkey (Türkiye)

About this study

Official title: A Prospective, Randomized Controlled Study Comparing the Analgesic Efficacy of Bupivacaine Infiltration of the Gallbladder Bed and Trocar Sites, Erector Spinae Plane Block, and Intrathecal Morphine in Patients Undergoing Laparoscopic Cholecystectomy

This study is designed to compare three different methods of pain control after laparoscopic gallbladder surgery (laparoscopic cholecystectomy). Although this surgery is minimally invasive, participants often experience different types of pain after the operation, such as pain at the incision site, pain inside the abdomen, and shoulder pain caused by the gas used during surgery.

The investigators will compare three commonly used pain relief techniques:

Read more

Local infiltration - injecting a numbing medicine (bupivacaine) into the gallbladder bed and at the sites where the surgical instruments are placed.

Erector spinae plane (ESP) block - an ultrasound-guided nerve block performed in the back to reduce both abdominal and incisional pain.

Intrathecal morphine - a very small dose of morphine given into the spinal fluid before surgery to provide long-lasting pain relief.

The goal is to determine which method provides the best pain control, reduces the need for opioid medications, and improves recovery after surgery.

Read the detailed description

Laparoscopic cholecystectomy is the standard surgical treatment for gallbladder diseases. Despite being a minimally invasive procedure, postoperative pain is a frequent problem and can negatively affect early mobilization, oral intake, and overall recovery. The pain experienced after this surgery is multifactorial, including somatic pain at trocar sites, visceral pain at the gallbladder bed, and shoulder pain caused by carbon dioxide insufflation. Effective pain management is therefore essential to improve patient comfort, reduce opioid consumption, and shorten hospital stay.

Several methods are available for postoperative analgesia. Local infiltration of the gallbladder bed and trocar sites with bupivacaine provides targeted pain relief at areas of surgical trauma. Erector spinae plane (ESP) block, a recently described ultrasound-guided regional anesthesia technique, offers both somatic and visceral analgesia with a favorable safety profile. Low-dose intrathecal morphine has also been shown to provide strong and prolonged analgesia in abdominal surgery, though its use may be limited by side effects such as nausea, vomiting, and itching.

This single-center, prospective, randomized controlled trial will compare the analgesic efficacy of three techniques:

Group INF (Infiltration): Bupivacaine infiltration at the gallbladder bed and trocar sites.

Group ESP: Bilateral ultrasound-guided ESP block at the T7 level.

Group ITM: Intrathecal morphine administration before induction of anesthesia.

The primary outcome is total opioid consumption within the first 24 hours after surgery.

Secondary outcomes include postoperative pain scores at multiple time points using the Visual Analog Scale (VAS), as well as the incidence of side effects such as nausea, vomiting, pruritus, and respiratory depression.

The results of this study are expected to provide evidence to guide multimodal analgesia strategies in laparoscopic cholecystectomy and to optimize patient recovery and satisfaction.

Being tested
Bupivacaine Infiltration, Erector Spinae Plane Block, Intrathecal Morphine
Keywords
Laparoscopic Cholecystectomy, Postoperative Pain, Bupivacaine Infiltration, Erector Spinae Plane Block, Intrathecal Morphine, Analgesia, Opioid Consumption
Medical subject headings
Pain, Postoperative, Agnosia

What participants receive

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

  • Bupivacaine InfiltrationDrug

    Also called Marcaine; Local Infiltration

    After removal of the gallbladder, 40 mL of 0.25% bupivacaine will be applied to the gallbladder bed with a sterile sponge for 10-15 minutes. At the end of the surgery, 15 mL of 0.25% bupivacaine will be infiltrated into trocar insertion sites (5 mL umbilical port, 5 mL epigastric port, 5 mL each auxiliary port).

  • Erector Spinae Plane BlockProcedure or surgery

    Also called ESP Block; Regional Anesthesia

    Before induction of anesthesia, a bilateral ultrasound-guided erector spinae plane block will be performed at the T7 transverse process level. A total of 40 mL of 0.25% bupivacaine will be injected (20 mL per side) using an in-plane technique under ultrasound guidance.

  • Intrathecal MorphineDrug

    With the patient in the sitting position, a 27-gauge spinal needle will be inserted at the L3-L4 interspace. A dose of 100 mcg morphine will be administered intrathecally before induction of anesthesia.

Study groups in NCT07203794
Study groupRoleWhat they receive
Bupivacaine Infiltration GroupActive comparatorPatients will receive bupivacaine infiltration at the gallbladder bed and trocar sites following laparoscopic cholecystectomy. After removal of the gallbladder, 20 mL of 0.25% bupivacaine will be applied to the gallbladder bed using a sterile sponge for 10-15 minutes. At the end of surgery, a total of 20 mL 0.25% bupivacaine will be infiltrated at trocar insertion sites (8 mL umbilical port, 6 mL epigastric port, 3 mL each auxiliary port).
Receives: Drug: Bupivacaine Infiltration
Erector Spinae Plane Block GroupActive comparatorPatients will undergo bilateral erector spinae plane block under ultrasound guidance before induction of anesthesia. Under ultrasound guidance at the T7 transverse process level, a total of 40 mL of 0.25% bupivacaine will be injected bilaterally using an in-plane technique prior to induction of anesthesia.
Receives: Procedure: Erector Spinae Plane Block
Intrathecal Morphine GroupActive comparatorPatients will receive intrathecal morphine prior to induction of anesthesia. With the patient in a sitting position, a 27G spinal needle will be inserted at the L3-L4 interspace, and 200 mcg of morphine will be administered intrathecally before induction of anesthesia.
Receives: Drug: Intrathecal Morphine

What is being measured

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

  1. Total Opioid Consumption in the First 24 Hours

    The cumulative amount of opioid analgesic (fentanyl via patient-controlled analgesia device) used by each patient during the first 24 hours after laparoscopic cholecystectomy. This measure will evaluate the effectiveness of each intervention in reducing postoperative opioid requirement.

    Measured: 0-24 hours postoperatively

Secondary outcomes (4)
  1. Postoperative Pain Scores (Visual Analog Scale, VAS)

    Pain intensity will be assessed using the Visual Analog Scale (VAS, 0-10 ; 0 = no pain, 10 = worst imaginable pain) during active (movement) and passive (rest) conditions.

    Measured: At 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, and 24 hours postoperatively

  2. Incidence of Postoperative Nausea and Vomiting (PONV)

    Presence or absence of nausea and vomiting will be recorded to evaluate intervention-related side effects.

    Measured: 0-24 hours postoperatively

  3. Incidence of Pruritus

    Occurrence of itching will be recorded as a side effect possibly related to intrathecal morphine.

    Measured: 0-24 hours postoperatively

  4. Incidence of Respiratory Depression

    Respiratory depression will be defined as a respiratory rate < 8 breaths/min or oxygen saturation < 90% requiring intervention.

    Measured: 0-24 hours postoperatively

Timeline

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

  1. First posted2 Oct 2025
  2. Study start1 Dec 2025 (estimated)
  3. Primary completion1 Apr 2026 (estimated)
  4. Study completion2 Apr 2026 (estimated)

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
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
This is a single-center, prospective, randomized, parallel-group, controlled trial with three intervention arms. Eligible patients undergoing elective laparoscopic cholecystectomy will be randomly assigned in a 1:1:1 ratio to receive either bupivacaine infiltration of the gallbladder bed and trocar sites, bilateral ultrasound-guided erector spinae plane block, or intrathecal morphine. Each participant will receive only one of the three interventions in addition to standard general anesthesia and multimodal analgesia. The outcomes will be compared across groups to evaluate the relative analgesic efficacy of the interventions.
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
132 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07203794
Sponsor's protocol ID
B.30.2.ATA.0.01.00/616
Other IDs
2025/2
Acronym
ITM-ESP-IPLA
Status last verified
Nov 2025
First submitted
22 Sep 2025
Last updated
25 Nov 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual participant data (IPD) will not be shared because the study involves sensitive patient health information, and data confidentiality will be strictly maintained according to institutional ethical guidelines.

Publications

  • Motamed C, Bouaziz H, Franco D, Benhamou D. Analgesic effect of low-dose intrathecal morphine and bupivacaine in laparoscopic cholecystectomy. Anaesthesia. 2000 Feb;55(2):118-24. doi: 10.1046/j.1365-2044.2000.055002118.x.

    PubMed 10651671
  • Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016 Sep-Oct;41(5):621-7. doi: 10.1097/AAP.0000000000000451.

    PubMed 27501016
  • Altuntas G, Akkaya OT, Ozkan D, Sayin MM, Balas S, Ozlu E. Comparison of Intraabdominal and Trocar Site Local Anaesthetic Infiltration on Postoperative Analgesia After Laparoscopic Cholecystectomy. Turk J Anaesthesiol Reanim. 2016 Dec;44(6):306-311. doi: 10.5152/TJAR.2016.75983. Epub 2016 Dec 1.

    PubMed 28058142
  • Ahmed SM, Shabbir S, Rana NA, Khatoon A, Ghani UF, Basharat I, Khan MN, Hameed FM, Dar MF. Ideal Local Anesthetic for Intraperitoneal Gallbladder Bed Infiltration Following Laparoscopic Cholecystectomy: A Randomized Controlled Trial. Cureus. 2024 Oct 9;16(10):e71122. doi: 10.7759/cureus.71122. eCollection 2024 Oct.

    PubMed 39525126
  • Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003 Dec 6;362(9399):1921-8. doi: 10.1016/S0140-6736(03)14966-5.

    PubMed 14667752

Questions about this trial

What is this clinical trial studying?

A study testing Bupivacaine Infiltration, Erector Spinae Plane Block and Intrathecal Morphine in people with Postoperative Pain Management and Cholecystectomy, Laparoscopic, run by Ataturk 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 7 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: opening soon, as of the sponsor's last update on 25 Nov 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?

This study is still under way. Results are not available in the source record yet.

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

Contact İrem Ateş, Doçent Doctor (+90 532 740 12 58, driremates@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Total Opioid Consumption in the First 24 Hours (time frame: 0-24 hours postoperatively). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07203794, which also lists 5 linked publications.

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 25 Nov 2025.

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