EOI block useful component of multimodal analgesia regimens for upper abdominal surgeries, suggests study

Upper abdominal surgical incisions result in significant pain during and after surgery. While neuraxial techniques are the standard for managing pain, they can be linked to complications. There's a recognition of interfascial plane block techniques as a component of multimodal pain relief for upper abdominal surgeries with subcostal incisions, such as the TAP block, QL block, and ESP block. Recent study compared the effectiveness of the external oblique intercostal (EOI) block versus the subcostal transversus abdominis plane (TAP) block for postoperative pain management in patients undergoing upper abdominal surgeries.

The study involved 50 patients who were randomly assigned to receive either the EOI block or the subcostal TAP block. The primary outcome was the time to activation of patient-controlled analgesia (PCA) after the surgery. The researchers also assessed secondary outcomes such as 24-hour opioid consumption, pain scores, patient satisfaction, and block-related complications. The results showed that patients who received the EOI block had a significantly longer time to activation of the PCA compared to the subcostal TAP block group (610 minutes vs. 410 minutes, p=0.001). The 24-hour postoperative opioid (fentanyl) consumption was also lower in the EOI block group (102 μg vs. 123 μg, p=0.019). Patients in the EOI block group had better pain scores at 30 minutes and 6 hours, as well as higher patient satisfaction scores.

Conclusion

The researchers conclude that the EOI block provides more effective postoperative analgesia compared to the subcostal TAP block in patients undergoing upper abdominal surgeries. The EOI block was able to prolong the duration of PCA activation and reduce opioid consumption, leading to better pain control and higher patient satisfaction. No significant block-related complications were observed in either group.

Future Implications

The authors suggest that the EOI block may be a useful component of multimodal analgesia regimens for upper abdominal surgeries, as it can effectively target the lateral and anterior cutaneous branches of the intercostal nerves. Further studies comparing the EOI block to other regional anesthesia techniques, such as erector spinae or paravertebral blocks, may provide additional insights into the optimal pain management strategies for this patient population.

Key Points

1. The study compared the effectiveness of the external oblique intercostal (EOI) block versus the subcostal transversus abdominis plane (TAP) block for postoperative pain management in patients undergoing upper abdominal surgeries.

2. The primary outcome was the time to activation of patient-controlled analgesia (PCA) after the surgery, and the researchers also assessed secondary outcomes such as 24-hour opioid consumption, pain scores, patient satisfaction, and block-related complications.

3. Patients who received the EOI block had a significantly longer time to activation of the PCA compared to the subcostal TAP block group, and their 24-hour postoperative opioid consumption was also lower.

4. Patients in the EOI block group had better pain scores at 30 minutes and 6 hours, as well as higher patient satisfaction scores.

5. The researchers concluded that the EOI block provides more effective postoperative analgesia compared to the subcostal TAP block in patients undergoing upper abdominal surgeries.

6. The authors suggest that the EOI block may be a useful component of multimodal analgesia regimens for upper abdominal surgeries, and further studies comparing the EOI block to other regional anesthesia techniques may provide additional insights.

Reference –

Shrey S, Sinha C, Kumar A, Kumar A, Kumar A, Nambiar S. Comparison of analgesic efficacy of ultrasound‑guided external oblique intercostal plane block and subcostal transverses abdominis plane block in patients undergoing upper abdominal surgery: A randomised clinical study. Indian J Anaesth 2024;68:965‑70