External oblique intercostal plane block versus quadratus lumborum block for pain after open upper abdominal surgery

Ultrasound Guided Techniques for Postoperative Analgesia in Patients Undergoing Open Upper Abdominal Surgeries: External Oblique Intercostal Plane Block vs. Quadratus Lumborum Block; A Randomized Controlled Trial

This trial will try two ultrasound-guided nerve blocks to see which gives better pain relief and reduces opioid use for adults having elective open upper abdominal surgery.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 80 (estimated)
• Ages: 18 Years to 60 Years
• Sex: All
• Sponsor: Cairo University (Academic / other)
• Locations: 1 site (Cairo)
• Trial ID: NCT07094386 on ClinicalTrials.gov

What this trial studies

Adults scheduled for elective open upper abdominal operations with subcostal incisions will receive one of two ultrasound-guided regional analgesic techniques: the external oblique intercostal plane block (EOIPB) or the quadratus lumborum block (QLB), each using 0.25% isobaric bupivacaine. Patients will be monitored after surgery for pain scores, opioid consumption, adverse events, and recovery milestones such as mobilization and length of stay. The trial compares analgesic efficacy and safety between the two blocks to determine which provides better postoperative pain control and contributes to faster recovery. Standard perioperative care and multimodal analgesia practices will be followed alongside the assigned block.

Who should consider this trial

Good fit: Adults aged 18–60 years with ASA physical status I–III and BMI 18.5–35 kg/m2 who are scheduled for elective open upper abdominal surgery are eligible.

Not a fit: Patients with coagulation defects, significant hepatic or renal impairment, known bupivacaine allergy, pre-existing myopathy, those who refuse the block, or those outside the age/BMI ranges are unlikely to qualify or benefit from this trial.

Why it matters

Potential benefit: If one block proves superior, patients could experience better pain control, lower opioid requirements, and potentially faster recovery with fewer side effects.

How similar studies have performed: Some regional blocks such as quadratus lumborum block have shown reduced postoperative opioid use and improved pain after abdominal surgery, while the external oblique intercostal plane block is less well studied and direct head-to-head comparisons are limited.

Eligibility criteria

Inclusion Criteria:

* Patients from both sexes.
* 18 to 60 years old.
* ASA physical status I- III scheduled for elective open upper abdominal surgeries, as (open nephrectomy, open cholecystectomy, liver resection, ….).
* Patients with BMI (18.5-35) kg/ m2.

Exclusion Criteria:

* Patients uncooperative or refuse to sign the consent of regional block.
* Patients with known coagulation defects. International normalized ratio (INR)\> 1.5), and thrombocytopenia if platelet count \< 100.000).
* Patients with known hypersensitivity to bupivacaine, or any of the used drugs.
* Patients with hepatic impairment, as Child-Pugh class B or C, AST/ALT \> 3 times the upper limit of normal, or total bilirubin \> 2 mg/dL.
* Patients with renal impairment, chronic kidney disease stage 4 or 5 (eGFR \< 30 mL/min/1.73 m²), or on regular dialysis.
* Patients with pre-existing myopathy, defined as a clinically diagnosed muscular disorder characterized by muscle weakness, elevated creatine kinase levels, or a history of inherited or acquired muscle disease (e.g., polymyositis, muscular dystrophy).
* Patients with pre-existing neuropathy, if clinically diagnosed as peripheral or central nerve dysfunction, including chronic sensorimotor deficits or conditions such as diabetic neuropathy, radiculopathy, or multiple sclerosis.
* Patients with chronic pain syndromes, defined as pain persisting for more than 3 months, including fibromyalgia, complex regional pain syndrome (CRPS), or chronic pain requiring long-term opioid or neuropathic pain medications.
* Patients with sepsis at the site of injection.
* Patients with history of long-acting opioids or steroids preoperatively

Where this trial is running

Cairo

• Cairo university hospitals — Cairo, Egypt (Recruiting)

Study contacts

• Study coordinator: Nesrine Elrefai, Professor

Conditions Post Operative Pain