Rhomboid Intercostal Block vs Erector Spinae Block (RIB-ESPB)

Cairo University (CU)

Status: Enrolling

Conditions: Lung Cancer

Treatments: Procedure: Ultrasound-guided Rhomboid Intercostal Block; Procedure: Ultrasound-guided Erector Spinae Plane Block

Study type: Interventional

Funder types: Other

Identifiers

NCT07040618

NCI-CAIRO-RIb-ESPB-2025

Details and patient eligibility

About

This randomized trial compares rhomboid intercostal block (RIB) and erector spinae plane block (ESPB) for postoperative pain control in lung cancer patients undergoing thoracotomy. Sixty patients will be assessed for 24-hour morphine consumption, pain scores, hemodynamics, recovery time, satisfaction, and side effects. The study aims to identify the more effective technique for enhancing recovery and minimizing opioid use.

Full description

This randomized clinical trial aims to evaluate the analgesic efficacy of two ultrasound-guided regional anesthesia techniques-Rhomboid Intercostal Block (RIB) and Erector Spinae Plane Block (ESPB)-in female lung cancer patients undergoing thoracotomy at the National Cancer Institute, Cairo University. Thoracotomy is known for causing severe postoperative pain, which, if not effectively managed, can lead to chronic pain and impaired pulmonary function. Traditional techniques like thoracic epidural or paravertebral blocks, while effective, have limitations due to technical complexity and potential complications. Recently, interfascial plane blocks such as ESPB have shown promise for thoracic analgesia, and RIB has emerged as a technique potentially offering superior lateral thoracic wall coverage.

Sixty patients will be randomly assigned to receive either RIB or ESPB 30-45 minutes before surgery. The primary outcome is 24-hour postoperative morphine consumption. Secondary outcomes include visual analog scale (VAS) pain scores, hemodynamic stability, time to first analgesic request, recovery duration, patient satisfaction, and incidence of nausea and vomiting.

General anesthesia will be standardized across both groups. Data will be analyzed using appropriate statistical tests, and ethical approval will be obtained prior to patient enrollment. This study supports multimodal analgesia and aims to inform clinical practice in pain management after oncologic thoracic surgery.

Enrollment: 60 estimated patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• patients undergoing thoracotomy for lung cancer

Age ≥ 18 years and ≤ 65 years

ASA physical status II or III

Body Mass Index (BMI) > 20 kg/m² and < 35 kg/m²

Willing and able to provide informed consent

Exclusion criteria

Patient refusal

ASA physical status IV

Age < 18 years or > 65 years

BMI < 20 kg/m² or > 35 kg/m²

Known allergy or contraindication to local anesthetics or opioids used in the study

History of chronic pain or psychological disorders

Contraindications to regional anesthesia (e.g., local infection, coagulopathy, pre-existing peripheral neuropathy)

Severe respiratory, cardiac, hepatic, or renal disease

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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60 participants in 2 patient groups

Ultrasound-guided Rhomboid Intercostal Block

Experimental group

Description:

Patients in this group will receive a rhomboid intercostal block with 20-25 mL of 0.25% bupivacaine injected between the rhomboid major and intercostal muscles under ultrasound guidance 30-45 minutes before surgery.

Treatment:

Procedure: Ultrasound-guided Rhomboid Intercostal Block

Ultrasound-guided Erector Spinae Plane Block

Active Comparator group

Description:

Patients in this group will receive an erector spinae plane block with 20-25 mL of 0.25% bupivacaine injected deep to the erector spinae muscle at the T4-T5 level under ultrasound guidance 30-45 minutes before surgery.

Treatment:

Procedure: Ultrasound-guided Erector Spinae Plane Block