Postoperative Analgesic Efficacy of Recto Intercostal Nerve Block

Ankara Etlik City Hospital

Status: Begins enrollment this month

Conditions: Laparoskopic Cholecystectomy; Recto Intercostal Nerve Block

Treatments: Procedure: The group without the rectointercostal nerve block; Procedure: The rectointercostal plane block

Study type: Interventional

Funder types: Other

Identifiers

NCT07003698

AEŞH-EK-2025-009

Details and patient eligibility

About

Laparoscopic cholecystectomy is a frequently performed surgery and the gold standard for the treatment of symptomatic gallstone disease. Although laparoscopic cholecystectomy is considered minimally invasive, it can cause moderate to severe pain in the postoperative period. Poorly controlled early postoperative pain impairs recovery quality and increases the risk of postoperative pulmonary complications, serving as a risk factor for chronic pain development.

Multimodal analgesia, including opioids, is used to manage pain following laparoscopic cholecystectomy. However, opioid treatment may lead to side effects such as postoperative nausea and vomiting (PONV), respiratory depression, and constipation.

The primary aim of this study is to evaluate the effect of recto-intercostal nerve block as part of multimodal analgesia on intraoperative opioid consumption and postoperative pain scores in patients undergoing laparoscopic cholecystectomy.

Enrollment: 60 estimated patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 18 to 65 years old
• American Society of Anesthesiologists (ASA) physical status I-II-III
• Elective laparoscopic cholecystectomy surgery

Exclusion criteria

• Under 18 and over 65 years old
• ASA score IV and above
• Advanced co-morbidity
• History of bleeding diathesis
• Patient refusing the procedure
• Chronic opioid or analgesic use
• Patients who will operate under emergency conditions
• Block injection site infection
• Known allergy to local anesthetics
• Pregnancy

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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60 participants in 2 patient groups

The group without rectointercostal nerve block

Active Comparator group

Description:

Patients in this group will be administered dexketoprofen 50 mg and tramadol 100 mg intravenously in the intraoperative period. These patients will not receive the rectointercostal nerve block.

Treatment:

Procedure: The group without the rectointercostal nerve block

Postoperative analgesic efficacy of rectointercostal nerve block

Active Comparator group

Description:

The patient lies in the supine position. The skin is disinfected. A high-frequency linear probe (6-13 MHz) is placed lateral to the xiphoid to visualize the rectus abdominis muscle at the level of the 7th rib. Using an in-plane technique, a 22G, 80 mm block needle is inserted in a cranial direction into the interfascial plane immediately inferolateral to the xiphoid, between the rectus abdominis muscle and the 6th-7th costal cartilages. A total of 20 ml of local anesthetic solution is injected bilaterally (40 ml of 0.25% bupivacaine (marcaine)). The spread of the local anesthetic is confirmed by ultrasound guidance. Additionally, patients in this group will be administered dexketoprofen 50 mg and tramadol 100 mg intravenously in the intraoperative period.

Treatment:

Procedure: The rectointercostal plane block