External Oblique Intercostal Block Versus Transversus Abdominis Plane Block in Pediatric Laparoscopic Splenectomy

NCT ID: NCT07336043

Last Updated: 2026-01-13

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 60 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2026-01-13
• Study Completion Date: 2026-07-30

Brief Summary

The aim of study is to compare the efficacy of the External Oblique Intercostal plane block with the Transversus Abdominis Plane block in acute postoperative pain control in pediatric patients undergoing laparoscopic Splenectomy.

Detailed Description

Optimal postoperative pain control in children is particularly challenging despite advances in multimodal pharmaceutical strategies. Laparoscopic approaches have improved postoperative outcomes when compared to open surgery, particularly in terms of postoperative pain. Pain after laparoscopic surgeries has three components; including incisional, visceral, and referred shoulder pain secondary to peritoneal insufflation. Opioid analgesia can be an effective adjunct to an existing non-opioid pain regimen. However, opioids are known to decrease bowel motility, result in nausea, and cause respiratory depression, particularly in the pediatrics. Traditionally, neuraxial blocks have been used for abdominal surgeries but in patients with low platelet count as splenectomy, this might not be a feasible option.

Effective fascial plane blocks have recently become popular as candidates to be a part of multimodal analgesia, especially for patients who require limited use of drugs in multimodal analgesia (such as liver failure, renal failure, platelet dysfunction, and peptic ulcer) or those with hypersensitivity to any of these drugs. As there are potential advantages such as a longer distance between the needle and neurovascular structures, less motor blockade and less hemodynamic change, fascial plane blocks can provide effective solutions to many difficulties faced by anesthesiologists in the perioperative period. Transversus Abdominis Plane block has emerged as an effective method to minimize postoperative pain in adult patients undergoing abdominal surgery. Several randomized trials in children undergoing laparoscopic appendicectomy, minimally invasive cholecystectomy, and other laparoscopic abdominal procedures have demonstrated that ultrasound-guided Transversus Abdominis Plane block reduces pain scores, opioid consumption, and even pulmonary complications such as atelectasis when compared with port site infiltration or systemic analgesia alone.

External oblique intercostal block is a novel block, which has been described as an important modification of the fascial plane blocks that can consistently involve the upper lateral abdominal walls. External oblique intercostal block block targets the external oblique intercostal plane, allowing for effective analgesia across the upper abdominal wall, including both median and lateral regions. This contrasts with the Transversus Abdominis Plane block block, which may not adequately cover the lateral cutaneous intercostal branches, limiting its effectiveness in certain surgical procedures. Many previous studies that have concentrated on the use of different TAP block strategies, including subcostal Transversus Abdominis Plane block; have shown that it could not sufficiently block the lateral cutaneous intercostal branches.

The aim of study is to compare the efficacy of the External Oblique Intercostal plane block with the Transversus Abdominis Plane block in acute postoperative pain control in pediatric patients undergoing laparoscopic Splenectomy.

• Primary outcome: Postoperative Numerical rating scale score.
• Secondary outcomes

1. The amount of morphine consumption postoperatively.

2. Time to first opioid request .

3. Intraoperative fentanyl consumption.

4. Intraoperative vital signs including mean arterial pressure and heart rate.

Conditions

Regional Block; Pediatric; Laparoscopic Splenectomy; External Oblique Intercostal Block; Transversus Abdominis Plane Block

Study Design

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

Study Groups

EOI group (Group E)

30 patients will receive ultrasound-guided left EOI block

Group Type: EXPERIMENTAL

EOI group

Intervention Type: PROCEDURE

patients will receive ultrasound-guided left EOI block.

TAP group (Group T)

30 patients will receive ultrasound-guided left TAP block

Group Type: EXPERIMENTAL

TAP group

Intervention Type: PROCEDURE

patients will receive ultrasound-guided left TAP block

Interventions

EOI group

patients will receive ultrasound-guided left EOI block.

Intervention Type: PROCEDURE

TAP group

patients will receive ultrasound-guided left TAP block

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Children of both gender,
• aged 8 to 16 years with American Society of Anesthesiologists Physical Status I to III,
• who were scheduled for laparoscopic Splenectomy surgery.

Exclusion Criteria

• Parents declined to participate in the trial.
• Physical or developmental delay.
• Pre-existing renal or cardiovascular disease, bone disease, or gastrointestinal disorders.
• Infection at proposed injection sites.
• Prior major abdominal surgery

• Minimum Eligible Age: 8 Years
• Maximum Eligible Age: 16 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Tanta University

OTHER

Sponsor Role: lead

Responsible Party

Esraa Rabie Amer

Lecturer

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Tanta University

Tanta, , Egypt

Countries

Egypt

Central Contacts

Esraa Rabie Amer, Lecturer

Role: CONTACT

Esraa.rabiea@med.tanta.edu.eg

01095917066

Facility Contacts

Esraa Amer, Lecturer

Role: primary

Esraa.rabiea@med.tanta.edu.eg

+20 10 95917066

Other Identifiers

36264PR131092/11/25

Identifier Type: -

Identifier Source: org_study_id