Rhomboid Intercostal and Subserratus Plane Block Versus Quadratus Lumborum Block in Management of Postoperative Pain After Open Nephrectomy

NCT ID: NCT06983249

Last Updated: 2025-09-11

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 50 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-07-01
• Study Completion Date: 2026-09-01

Brief Summary

Rhomboid intercostal block (RIB) and Rhomboid intercostal block with sub-serratus plane block (RISS) are the two types of plane blocks used for postoperative analgesia after abdominal surgeries.

For achieving proper postoperative analgesia, multimodal regimens have been described for patients undergoing abdominal procedures like cholecystectomy. These multimodal regimens could include opioid medications, non-opioid analgesics (e.g., acetaminophen and ketorolac), and regional blocks. These modalities could be used alone or in combination. This prospective randomised controlled trial was performed to analyse the postoperative analgesic effects of ultrasound guided Quadratus lumborum block and RISS block in managing post operative pain in patients undergoing open nephrectomy.

Detailed Description

Open nephrectomy is an important surgery in treatment of patients with renal cancer, ultrasound guidance is rapidly becoming the gold standard for regional anesthesia. There is an evidence matched with improving technology to show that the use of ultrasound has significant benefits over conventional techniques, such as nerve stimulation and loss of resistance. The improved safety and efficacy that ultrasound brings to regional anesthesia helped promote its use and realize the benefits that regional anesthesia has over general anesthesia, such as decreased morbidity and mortality, superior post-operative analgesia, cost-effectiveness, decreased postoperative complications and an improved postoperative course .

The Rhomboid intercostal and subserratus plane block (RISS) is a relatively newer block technique described by Elsharkawy et al.

The RISS provides analgesia for the regions supplied by T3 - T6 thoracic nerves, analgesia of the RISS block may be due to two different mechanisms. First, the block mainly affects the thoracic intercostal dorsal rami emerging under the erector spinae muscle at the level of T3-T9, where it is attached to the transverse spinal processes. Second, the injected local anesthetic may extend to the paravertebral space under the erector spinae muscle Quadratus lumborum block (QLB) is a new abdominal truncal block for controlling somatic pain in both the upper and lower abdomen.

Although the concept of the block is similar to that of lateral transverses-abdominis plane block (TAPB), the extent of the effect has been suggested to be greater because the point of injection is more dorsal. Local anesthetics are administered into the space between the quadratus lumborum muscle and the medial layer of the thoracolumbar fascia to achieve QLB, which can spread to the paravertebral space .

Conditions

Open Nephrectomy Surgery

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: SINGLE

Study Groups

Quadratus lumborum nerve block in nephrectomy

Qudaratus lumborum nerve block ultrasound guided in nephrectomy

Group Type: EXPERIMENTAL

Quadratus lumborum nerve block in nephrectomy

Intervention Type: PROCEDURE

Ultrasound guided posterior quadrates lumborum block was done in lateral decubitus position and linear probe according to the depth was placed in the midaxillary line in the transverse plane immediately above the iliac crest and then it was slided dorsally until the "Shamrock sign" was clearly identified. In "Shamrock sign" The quadratus lumborum (QL) muscle is seen as a superior leaf of the Shamrock at the apex of the transverse process (TP) of L4

Rhomboid intercostal and Sub-serratus nerve block in nephrectomy

Rhomboid intercostal and subserratus nerve block ultrasound guided

Group Type: EXPERIMENTAL

Rhomboid intercostal and Sub-serratus nerve block in nephrectomy

Intervention Type: PROCEDURE

That block was performed when the patient was in the lateral position. A high frequency linear ultrasound transducer was placed longitudinally on the patient's back, just 2 cm medial to the medial scapular border. Then, the probe was slightly rotated to obtain an oblique parasagittal plane. The following landmarks were identified: the trapezius muscle, rhomboid major muscle, intercostal muscles, pleura, and lungs (from superficial to deep in order of appearance). Under ultrasound guidance, a 22 mm gauge spinal needle was directed to the plane by using high frequency ultrasound guidence (Sono SiteTM, Inc., Bothell, WA 98021, USA) between the rhomboid major and the underlying intercostal muscles and 15 ml bupivacaine (0.25%) was delivered into that plane (after repeated negative aspiration of blood), and its spread was manifested by the hydrodissection and widening of the plane visualized by ultrasound

Interventions

Rhomboid intercostal and Sub-serratus nerve block in nephrectomy

That block was performed when the patient was in the lateral position. A high frequency linear ultrasound transducer was placed longitudinally on the patient's back, just 2 cm medial to the medial scapular border. Then, the probe was slightly rotated to obtain an oblique parasagittal plane. The following landmarks were identified: the trapezius muscle, rhomboid major muscle, intercostal muscles, pleura, and lungs (from superficial to deep in order of appearance). Under ultrasound guidance, a 22 mm gauge spinal needle was directed to the plane by using high frequency ultrasound guidence (Sono SiteTM, Inc., Bothell, WA 98021, USA) between the rhomboid major and the underlying intercostal muscles and 15 ml bupivacaine (0.25%) was delivered into that plane (after repeated negative aspiration of blood), and its spread was manifested by the hydrodissection and widening of the plane visualized by ultrasound

Intervention Type: PROCEDURE

Quadratus lumborum nerve block in nephrectomy

Ultrasound guided posterior quadrates lumborum block was done in lateral decubitus position and linear probe according to the depth was placed in the midaxillary line in the transverse plane immediately above the iliac crest and then it was slided dorsally until the "Shamrock sign" was clearly identified. In "Shamrock sign" The quadratus lumborum (QL) muscle is seen as a superior leaf of the Shamrock at the apex of the transverse process (TP) of L4

Intervention Type: PROCEDURE

Other Intervention Names

Rhomboid intercostal and subserratus nerve block; QLB

Eligibility Criteria

Inclusion Criteria

• Patients undergoing open nephrectomy.
• ASA physical status II, III
• Sex (males and females)
• Age 40-70 years

Exclusion Criteria

Patient refusal or with difficulties in comprehending visual analogue scale (VAS) pain scores

• Any contraindications for regional anesthesia. (eg: coagulopathy, use of anticoagulants or antiplatelets...)
• Hypersensitivity to local anesthetics.
• Infection near site of injection.

• Minimum Eligible Age: 40 Years
• Maximum Eligible Age: 70 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Ain Shams University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

Ainshams university

Cairo, Cairo Governorate, Egypt

Countries

Egypt

References

Elsharkawy H, Hamadnalla H, Altinpulluk EY, Gabriel RA. Rhomboid intercostal and subserratus plane block -a case series. Korean J Anesthesiol. 2020 Dec;73(6):550-556. doi: 10.4097/kja.19479. Epub 2020 Feb 12.

Reference Type: BACKGROUND

PMID: 32046475 (View on PubMed)

West D. Evaluation of rhomboid intercostal and subserratus plane block under direct vision for postoperative analgesia in thoracic surgeries: a prospective, randomized controlled trial, thoracic non-oncologic. Eur J Cardiothorac Surg. 2022 Nov 3;62(6):ezac532. doi: 10.1093/ejcts/ezac532. No abstract available.

Reference Type: BACKGROUND

PMID: 36367247 (View on PubMed)

Kozanhan B, Semerkant T, Esme H, Canitez A, Iyisoy MS. Evaluation of rhomboid intercostal and subserratus plane block under direct vision for postoperative analgesia in thoracic surgeries: a prospective, randomized controlled trial. Eur J Cardiothorac Surg. 2022 Nov 3;62(6):ezac498. doi: 10.1093/ejcts/ezac498.

Reference Type: BACKGROUND

PMID: 36218395 (View on PubMed)

Other Identifiers

MD186/2024

Identifier Type: -

Identifier Source: org_study_id