Overview
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.
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.
Eligibility
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
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