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External Oblique Intercostal Plane Block for Postoperative Analgesia After Major Upper Abdominal Surgery

Sponsor: Jun Zhang • ClinicalTrials.gov ID: NCT07331441

Registry updated: 2026-09-01

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Description

Postoperative pain after laparoscopic major upper abdominal surgery (e.g., gastric, hepatic, gallbladder, pancreatic surgery) is often severe, and inadequate analgesia may lead to increased opioid use, opioid dependence, and poor functional recovery. Current analgesic techniques such as neuraxial block have safety concerns (e.g., hypotension, neurological injury), while transversus abdominis plane (TAP) block is ineffective for blocking the lateral cutaneous branches of intercostal nerves in the upper abdomen. The External Oblique Intercostal Plane Block (EOIB) is a novel regional block technique that has shown promise in reducing postoperative opioids and pain in small-scale studies, but evidence for its use in major upper abdominal surgery is limited. This randomized controlled trial (RCT) aims to evaluate the analgesic efficacy and safety of bilateral EOIB combined with standard multimodal analgesia versus standard multimodal analgesia alone in patients undergoing elective laparoscopic major upper abdominal surgery. The primary outcome is the total postoperative opioid consumption (measured as Morphine Milligram Equivalents, MME) within 24 hours. Secondary and additional outcomes include pain scores (Verbal Rating Scale, VRS), recovery quality (QoR-15 scale), incidence of adverse events, and hospital stay.

Interventions

External Oblique Intercostal Plane Block (Procedure)
Ultrasound-guided bilateral external oblique intercostal plane block (EOIB) performed after induction of general anesthesia and before surgical incision. Using an in-plane technique at the 6th rib level, 25 mL 0.3% ropivacaine per side is injected between the external oblique muscle and the intercostal muscle. Standard multimodal analgesia is also provided to all participants.
Standard multimodal analgesia (Other)
Standard multimodal analgesia per institutional ERAS practice, including intravenous patient-controlled analgesia (IV PCA) with opioids and adjunct non-opioid analgesics (e.g., NSAIDs and/or acetaminophen) with antiemetic prophylaxis as needed. No regional block is administered.

Eligibility criteria

Inclusion Criteria: * Obtain written informed consent from participants or their legal representatives * Age between 18 and 85 years * American Society of Anesthesiologists (ASA) physical status classification I-III * Scheduled for elective laparoscopic major upper abdominal surgery (e.g., gastric, hepatic, gallbladder, pancreatic surgery) * Expected surgical duration ≥ 2 hours * Ability to use the intravenous patient-controlled analgesia (IV PCA) system Exclusion Criteria: * Hepatic disease (liver enzyme levels ≥ 2× the upper limit of normal) * Renal disease (serum creatinine levels ≥ 2× the upper limit of normal) * Allergy to local anesthetics or known study-related drugs * Pregnancy or lactation * Low surgical incision site (not involving the upper abdominal wall innervated by T6-T10 nerves) * Coagulopathy or current use of anticoagulant medications * Opioid use for more than 2 weeks in the past 6 months

Conditions

Abdominal Surgery Postoperative Pain

Locations

Fudan University Shanghai Cancer Center — Shanghai, China

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Official Source

Data sourced from ClinicalTrials.gov, a service of the U.S. National Institutes of Health.

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