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Comparative Effects of ESP Block and EOIP Block on Postoperative Respiratory Recovery Following Liver Resection

Sponsor: Menoufia University • ClinicalTrials.gov ID: NCT07740382

Registry updated: 2026-10-06

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Description

This study evaluates respiratory recovery as a multidimensional construct using clinically relevant and measurable parameters, including LUS, diaphragmatic excursion, oxygen requirement, and PPCs. The investigators hypothesize that bilateral ESP block improves postoperative respiratory function compared with EOIP block following open hepatic surgery. The investigators further hypothesize that this improvement is mediated, in part, by superior analgesia.

Interventions

Ultrasound-guided bilateral external oblique intercostal plane (EOIP) block (Procedure)
Bilateral ESP block * after induction of general anesthesia and before surgical incision. * T7 or T8 transverse process, selected consistently by protocol. * high-frequency linear probe when feasible; curvilinear probe in larger habitus. In-plane cranial-to-caudal or caudal-to-cranial approach to the fascial plane deep to erector spinae muscle and superficial to the transverse process. * Injectate: 20 mL of 0.25% bupivacaine per side after negative aspiration; hydrodissection used to confirm correct plane. Bilateral EOIP block * after induction of general anesthesia and before surgical incision. * ultrasound-guided injection into the fascial plane between the external oblique muscle and the intercostal muscle/external intercostal membrane near the 6th-8th intercostal spaces on each side, following the institutional standardized approach. * Injectate: 20 mL of 0.25% bupivacaine per side Safter negative aspiration.
Ultrasound-guided bilateral erector spinae plane (ESP) block (Procedure)
An ultrasound-guided bilateral ESP block will be performed after induction of general anaesthesia and before surgical incision. The block will be administered at the T7 or T8 transverse process using an in-plane ultrasound-guided approach. Twenty millilitres of 0.25% bupivacaine will be injected on each side into the fascial plane deep to the erector spinae muscle and superficial to the transverse process after negative aspiration. Correct spread of local anaesthetic will be confirmed by hydrodissection.

Eligibility criteria

Inclusion Criteria: * Adult patients aged 18-75 years * Adult with American Society of Anesthesiologists (ASA) physical status I-III * Scheduled for elective hepatic surgery via upper abdominal incisions will be eligible. * All participants will be required to understand the Numeric Rating Scale (NRS) and provide informed consent. Exclusion Criteria: * Patient refusal * Coagulopathy (INR\>1.4 or platelet count\<8 x 104) * Contraindications to fascial plane blocks * Infection at the puncture site * Known allergy to study medications * Chronic opioid use or chronic pain syndromes * Severe chronic respiratory failure requiring home oxygen or noninvasive ventilation * Pregnancy * Body mass index\>40 kg/m² * When ultrasound imaging will be deemed unreliable * Emergency surgery * Hemodynamic instability * Reoperation during the same hospital admission. * Patients scheduled preoperatively for elective postoperative mechanical ventilation or planned ICU intubation.

Conditions

Liver Resection Upper Abdominal Surgeries

Locations

National Liver Institute, Menoufia University — Alexandria, Sbein-Elkom, Egypt

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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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