RecruitingNot ApplicableNCT07164664

External Oblique Intercostal Block in Laparoscopic Cholecystectomy

External Oblique Intercostal Block Versus Port-Site Infiltration for Postoperative Analgesia in Laparoscopic Cholecystectomy

Sponsor

Ondokuz Mayıs University

Enrollment

60 participants

Start Date

Sep 10, 2025

Study Type

INTERVENTIONAL

Conditions

Opioid Use Pain, Postoperative Pain, Acute

Summary

Adequate postoperative pain management is essential for improving patient comfort and recovery after laparoscopic cholecystectomy. This study evaluated the effectiveness of the external oblique intercostal block compared with port-site infiltration in terms of pain scores and opioid consumption during the first 24 hours after surgery.

Eligibility

Min Age: 18 YearsMax Age: 75 Years

Inclusion Criteria4

Patients aged 18-75 undergoing elective Laparoscopic Cholecystectomy
American Society of Anesthesiologists (ASA)classification I-III patients.
Patients who can use PCA.
Patients who will sign the informed consent form.

Exclusion Criteria9

They will refuse to participate.
They will have a body mass index (BMI) greater than 35 kg/m2.
They will have contraindications to peripheral nerve blocks (e.g., coagulopathy, abnormal INR, thrombocytopenia, local or systemic infection).
They will have clinically significant cardiovascular or cerebrovascular disease.
They will have severe hepatic, renal, or respiratory dysfunction. They will have known drug allergies.
They will have a history of substance abuse.
They will have chronic opioid use, defined as regular use of ≥15 mg oral morphine equivalent per day for at least 30 consecutive days within the past 3 months.
They will have chronic pain syndromes (e.g., fibromyalgia, diabetic neuropathy, or chronic low back pain).
They will have neuropsychiatric disorders or cognitive impairment that precludes effective communication with the investigators.

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Interventions

PROCEDUREExternal Oblique Intercostal Block

Bilateral ultrasound-guided External Oblique Intercostal Block (30 mL, 0.25% bupivacaine, bilaterally) will be performed. All patients will receive multimodal analgesia, including a single dose of IV tenoxicam 20 mg. Additionally, 15 mg/kg IV paracetamol (based on IBW) will be administered at skin closure and continued every 6 hours postoperatively. A standardized IV PCA protocol will be initiated using a PCA device programmed to deliver morphine boluses of 0.01-0.015 mg/kg (IBW), with a 6-minute lockout and a 4-hour maximum of 0.1-0.15 mg/kg (IBW). Upon arrival in the PACU, patients with a resting NRS ≥4 will receive titrated IV morphine boluses of 0.03 mg/kg (IBW; max 10 mg) every 10 minutes until pain is controlled. In the surgical ward, patients with breakthrough pain (NRS ≥4) despite PCA use will receive IV tramadol 1-1.5 mg/kg (IBW) in 50-100 mg slow doses, not exceeding 400 mg/day.All patients will receive 8 mg dexamethasone and 0.15 mg/kg ondansetron (IBW) for PONV prophylaxis.

PROCEDUREPort-Site Infiltration

Before port placement, 0.25% bupivacaine solution will be injected into the laparoscopic port insertion sites (5 mL at each port site).

DRUGıv morphine PCA

A standardized IV PCA protocol will be initiated for all patients using a PCA device (Body Guard 575 pain manager, UK), programmed to deliver morphine boluses of 0.01-0.015 mg/kg (IBW), with a 6-minute lockout and a 4-hour maximum dose of 0.1-0.15 mg/ kg (IBW). No basal infusion will be used.