Comparison of Serratus Intercostal Plane Blcok With Erector Spinae Plane Block for Open Nephrectomy

Summary

Effective postoperative pain management following open nephrectomy remains a significant clinical challenge.

Inadequate pain control after this procedure may lead to impaired respiratory function, delayed mobilization, prolonged hospital stay, increased opioid consumption, and a higher incidence of postoperative complications. Therefore, optimizing postoperative analgesia while minimizing opioid-related adverse effects is a key objective in perioperative care for patients undergoing open nephrectomy Traditionally, postoperative pain following open nephrectomy has been managed using systemic opioids, epidural analgesia, or paravertebral blocks.

Ultrasound-guided fascial plane blocks have emerged as valuable alternatives in modern regional anesthesia due to their simplicity, safety profile, and effectiveness. Among these techniques, the erector spinae plane (ESP) block has gained widespread popularity.

This block has been shown to provide effective analgesia for thoracic, abdominal, and urologic surgeries, including nephrectomy The ultrasound-guided serratus intercostal plane block (SIPB) is a more recently described regional anesthetic technique targeting the lateral cutaneous branches of the intercostal nerves by injecting local anesthetic between the serratus anterior muscle and the intercostal muscles or ribs By blocking these nerves, SIPB provides analgesia to the lateral thoracic wall and upper abdominal regions, which are particularly relevant to flank incisions used in open nephrectomy.

Patients will be randomly allocated into two equal groups. Patients in group (S) will receive serratus intercostal plane block and those in group (E) will receive Erector spinae plane block . Both of these blocks will be performed after induction of general anaesthesia by an experienced anaesthesiologist The aim of this study is to to compare the analgesic efficacy of ultrasound-guided serratus intercostal plane block and erector spinae plane block in patients undergoing open nephrectomy.

Conditions

• Post Operative Pain
• Open Nephrectomy

Interventions

PROCEDURE

Serratus Intercostal Plane Block

Block will be performed in the operating room, With the patient in the supine decubitus position, aseptic conditions were provided for the block, The high-frequency linear transducer of ultrasound (LOGIQ P7) will be placed in the mid-axillary line at the level of the eighths rib. The serratus anterior muscle and underlying intercostal muscles will be identified. A 22-gauge, 50 mm echogenic needle (Stimuplex D; B Braun, Germany) will be advanced in plane in the caudo-cranial direction. After negative aspiration, 25 mL of 0.25% bupivacaine HCl (plain)will be injected between the serratus anterior muscle and the intercostal muscles.

PROCEDURE

Erector Spinae Plane Block

Block will be performed in the operating room, With the patient in the lateral decubitus position, Aseptic conditions were provided for the block, The high-frequency linear transducer of ultrasound (LOGIQ P7) will be placed parasagittally at the level of the T8-T10 transverse process. The erector spinae muscle and transverse process will be identified. A 22-gauge, 50 mm echogenic needle (Stimuplex D; B Braun, Germany) will be advanced in plane in the cranio-caudal direction and after negative aspiration, 25 mL of 0.25% bupivacaine HCl (plain) will be injected deep to the erector spinae muscle.

Sponsors & Collaborators

• Fayoum University Hospital

  lead OTHER

Principal Investigators

• Mohamed A Hamed, MD · faculty of medicine, fayoum university

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

65 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2026-04-10

Primary Completion

2027-03-01

Completion

2027-06-01

Countries

• Egypt

Study Locations