Pain Blocks for Open Abdominal Surgery

Overseen By Ehab Farag, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: The Cleveland Clinic

Disqualifiers: Hepatic disease, Chronic kidney disease, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: Surgery day

100 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine which pain block method is more effective for individuals undergoing open upper abdominal surgery. Researchers are comparing two pain management blocks: the External Oblique Intercostal Fascial Plane Block and the Oblique Subcostal Transversus Abdominis Plane Block. The trial targets patients scheduled for surgeries like gastrectomy or hepatectomy, who anticipate needing strong pain relief, such as opioids, for at least 48 hours post-surgery. Participants should not have severe liver or kidney conditions or be scheduled for certain other types of surgeries. As an unphased trial, this study allows patients to contribute to medical knowledge and potentially enhance pain management techniques for future surgeries.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that both the External Oblique Intercostal Fascial Plane (EOIFP) block and the Oblique Subcostal Transversus Abdominis Plane (OSTAP) block are generally safe and effective for managing pain during surgeries.

Studies have found that the EOIFP block reduces the need for opioids and decreases pain after surgery, particularly in patients with obesity. This approach manages pain effectively without over-relying on medications that might have more side effects.

For the OSTAP block, research indicates it provides excellent pain relief after surgeries like stomach surgery and minimally invasive procedures. It also effectively relieves pain after open umbilical hernia repair. Ultrasound guidance enhances the procedure's precision and safety.

Both treatments use a combination of liposomal bupivacaine and bupivacaine, well-known anesthetics commonly used in medical settings, adding an extra layer of safety. Overall, evidence supports that both blocks are safe and effective for managing pain in abdominal surgeries. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these treatments because they offer new ways to manage pain after open abdominal surgery. Unlike traditional pain management options like opioids, which can have significant side effects, both the External Oblique Intercostal Fascial Plane Block and the Oblique Subcostal Transversus Abdominis Plane Block use ultrasound guidance to deliver a mix of liposomal bupivacaine and bupivacaine 0.25% directly to specific fascial planes. This targeted delivery method not only aims to reduce pain more effectively but also minimizes the need for systemic pain medication, potentially leading to fewer side effects and a quicker recovery. By focusing on these precise injection techniques, researchers hope to improve postoperative pain control significantly.

What evidence suggests that this trial's treatments could be effective for open abdominal surgery?

This trial will compare the effectiveness of two pain management techniques for open abdominal surgery. Research has shown that the Oblique Subcostal Transversus Abdominis Plane (OSTAP) block, one of the treatments participants may receive, effectively reduces pain after surgeries like stomach and liver operations. Studies have found it provides significant pain relief after abdominal surgeries. Meanwhile, the External Oblique Intercostal Fascial Plane (EOIFP) block, another treatment option in this trial, has helped with early recovery and reduced pain after surgery. One study even found it to be better than the OSTAP block for pain relief in upper abdominal surgeries. Both blocks numb the nerves in the abdominal area to reduce post-surgery pain, making them promising options for those undergoing abdominal surgery. ^{2 4 6 7 8}

Who Is on the Research Team?

Ehab Farag, MD

Principal Investigator

The Cleveland Clinic

Are You a Good Fit for This Trial?

This trial is for patients who are scheduled for open upper abdominal surgery. Specific eligibility criteria were not provided, so it's important to contact the study organizers for detailed information on who can participate.

Inclusion Criteria

My health is good to moderately impaired.

Written informed consent

Anticipated hospitalization of three nights

Exclusion Criteria

I have had surgery on my kidney or lower abdomen.

My liver enzymes are twice the normal level.

Allergic reaction to study medications

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive either the EOIFP block or the OSTAP block under ultrasound guidance during their upper abdominal surgery

Surgery day

1 visit (in-person)

Postoperative Monitoring

Participants are monitored postoperatively for pain management and recovery, with adjustments to analgesic management as necessary

3 days

Continuous monitoring

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• External Oblique Intercostal Fascial Plane Block
• Oblique Subcostal Transversus Abdominis Plane Block

Trial Overview The study is testing two types of nerve block techniques: EOIFP Block and OSTAP Block, to see which one is more effective in managing pain after open abdominal surgery. It's a randomized control trial where participants will be assigned to either technique by chance.

How Is the Trial Designed?

Group I: External Oblique Intercostal Fascial Plane block Experimental Treatment 1 Intervention

Researchers will perform the External Oblique Intercostal Fascial Plane block using sterile technique under ultrasound guidance. Once the target is visualized, a 20-gauge, 4-inch echogenic needle will be advanced in-plane to the fascial plane. 5 ml of 0.9% normal saline will be injected through the needle to open the fascial plane and then a single dose (10 ml) of liposomal bupivacaine mixed with 20 mL of bupivacaine 0.25% will be injected on each side.

Group II: Oblique Subcostal Transversus Abdominis Plane Block Active Control 1 Intervention

Researchers will perform the Oblique Subcostal Transversus Abdominis Plane Block using sterile technique under ultrasound guidance. Once the target is visualized, a 20-gauge, 4-inch echogenic needle will be advanced in-plane to the fascial plane. 5 ml of 0.9% normal saline will be injected through the needle to open the fascial plane and then a single dose (10 ml) of liposomal bupivacaine mixed with 20 mL of bupivacaine 0.25% will be injected on each side.

Who Is Running the Clinical Trial?

The Cleveland Clinic

Lead Sponsor

Trials

1,072

Recruited

1,377,000+

Published Research Related to This Trial

Both intercostal-iliac transversus abdominis plane (TAP) and oblique subcostal TAP (OSTAP) blocks significantly improved postoperative pain management in patients undergoing laparoscopic cholecystectomy, leading to lower visual analog scale (VAS) scores and reduced analgesic consumption compared to the control group.

Among the two techniques, the OSTAP block was particularly effective, resulting in lower VAS scores than both the TAP block and the control group, indicating it may provide superior pain relief in this surgical context.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transversus abdominis plane block as a component of multimodal analgesia for laparoscopic cholecystectomy. Oksar, M., Koyuncu, O., Turhanoglu, S., et al.[2018]

Transversus abdominis plane (TAP) blocks are generally considered safe and effective for pain relief in abdominal surgeries, making them a popular choice for perioperative analgesia.

However, there is a rare risk associated with TAP blocks, as demonstrated in a case where a patient developed an unusual abdominal wall abscess following the procedure, leading to complications in recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Severe Abdominal Wall Infection After Subcostal Transversus Abdominis Plane Block: A Case Report. Hang, D., Weich, D., Anderson, C., et al.[2021]

The transversus abdominis plane (TAP) block using ropivacaine significantly reduced post-operative pain levels (measured by visual analogue score) for 24 hours after caesarean section compared to a control group receiving normal saline.

Patients receiving the TAP block experienced a longer time before needing additional pain relief (rescue analgesia), extending from 4.1 hours to 9.53 hours, and required less tramadol in the first 24 hours, indicating improved pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound-guided transversus abdominis plane block for post-operative analgesia in patients undergoing caesarean section. Mankikar, MG., Sardesai, SP., Ghodki, PS.[2022]

In a study involving 60 patients undergoing laparoscopic cholecystectomy, both the Erector Spinae Plane Block (ESPB) and Oblique Subcostal Transversus Abdominis Plane Block (OSTAP) provided effective postoperative analgesia, significantly reducing pain intensity in the first 3 hours compared to a control group.

Both ESPB and OSTAP resulted in lower consumption of analgesics and reduced need for rescue pain relief, demonstrating that these regional anesthetic techniques can enhance the quality of multimodal analgesia after upper abdominal surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of Ultrasound-Guided Erector Spinae Plane Block and Oblique Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy: Randomized, Controlled, Prospective Study. Tulgar, S., Kapakli, MS., Kose, HC., et al.[2022]

The oblique subcostal transversus abdominis plane (OSTAP) block significantly reduced postoperative pain scores compared to standard care and the transversus abdominis plane (TAP) block in patients undergoing laparoscopic cholecystectomy, indicating its effectiveness as an analgesic method.

Patients receiving the OSTAP block required less rescue analgesics, specifically a reduced total fentanyl requirement, demonstrating its potential for improved pain management after surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound-guided oblique subcostal transversus abdominis plane block for analgesia after laparoscopic cholecystectomy: a randomized, controlled, observer-blinded study. Shin, HJ., Oh, AY., Baik, JS., et al.[2022]

In a study of 60 children aged 3-10 undergoing open inguinal hernia repair, the use of a transversus abdominis plane (TAP) block significantly reduced serum cortisol and blood glucose levels during and after surgery, indicating a lower neuroendocrine stress response compared to general anesthesia alone.

The TAP block also provided better quality of analgesia and reduced the need for postoperative rescue analgesia, demonstrating its effectiveness as part of a multimodal pain management strategy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of ultrasound-guided transversus abdominis plane (TAP) block on postoperative analgesia and neuroendocrine stress response in pediatric patients undergoing elective open inguinal hernia repair. Abu Elyazed, MM., Mostafa, SF., Abdullah, MA., et al.[2017]

The external oblique intercostal (EOI) block technique was shown to effectively target intercostal nerves T7 to T10, providing reliable analgesia for the upper midline and lateral abdominal wall, as demonstrated in a cadaveric study.

In a cohort of 22 patients, the EOI block resulted in consistent dermatomal sensory blockade from T6 to T10, indicating its potential for effective pain management in various clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The External Oblique Intercostal Block: Anatomic Evaluation and Case Series. Elsharkawy, H., Kolli, S., Soliman, LM., et al.[2022]

The external oblique intercostal (EOI) block demonstrated effective postoperative analgesia in three different surgeries, resulting in low pain scores and minimal opioid use in the first 72 hours for all patients.

Due to its broad innervation area and ease of application, the EOI block is suggested to be a valuable option for upper abdominal analgesia, particularly for obese patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The analgesic contribution of external oblique intercostal block: Case reports of 3 different surgeries and 3 spectacular effects. Coşarcan, SK., Erçelen, Ö.[2022]

The subcostal transverse abdominis plane (SCTAP) block offers superior pain relief for upper abdominal surgeries compared to the traditional transverse abdominis plane block, making it a more effective option for postoperative analgesia.

When combined with a four-quadrant transverse abdominis plane block, the SCTAP block can provide sufficient pain management for major abdominal surgeries, enhancing overall patient comfort during recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Subcostal Transverse Abdominis Plane Block for Acute Pain Management: A Review. Soliz, JM., Lipski, I., Hancher-Hodges, S., et al.[2020]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11972538/

The impact of external oblique intercostal block on early ... The aim of this study was to investigate the effects of external oblique intercostal nerve block (EOIB) on early postoperative pain and recovery ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0952818025002326

Ultrasound-guided external oblique intercostal plane block ... This study aims to evaluate and compare the efficacy of the external oblique intercostal plane (EOI) block and the subcostal TAP block in individuals who have ...

3. sciencexcel.com sciencexcel.com/articles/oELwsK2Bk3A0Szs8AUiYV4mIvYV2FGxhudB0PWB0.pdf

External Oblique—Intercostal (EOI) Fascial Plane Block for ... External oblique intercostal block vs erector spinae block for open upper abdominal surgery: a prospective study. Unpublished data. 2025. 12 ...

4. ekja.org ekja.org/journal/view.php?number=9034

Modified approach to external oblique intercostal block We present a modified external oblique intercostal block for complete lateral abdominal analgesia with a single injection.

5. bmcanesthesiol.biomedcentral.com bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-025-03030-0

The impact of external oblique intercostal block on early ... The aim of this study was to investigate the effects of external oblique intercostal nerve block (EOIB) on early postoperative pain and recovery ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11031435/

Ultrasound-Guided External Oblique Intercostal Plane ... The results of the current study demonstrated that bilateral EOI block reduced postoperative opioid consumption and postoperative pain in patients with obesity.

7. clinicaltrials.gov clinicaltrials.gov/study/NCT07055438

Bilateral External Oblique Intercostal Plane Bock (EOIPB) ... The current study is designed to investigate the analgesic potentials of two modalities of abdominal blocks where local anesthetics is injected in the ...

8. rapm.bmj.com rapm.bmj.com/content/49/Suppl_1/A40.2

OP051 Comparison of ultrasound guided external oblique ... Conclusions Ultrasound guided EOI Plane Block is a better analgesic technique than Subcostal TAP Block in patients undergoing upper abdominal surgeries with ...