External Oblique Intercostal Block Outperforms TAPB for Pain Relief After Open Nephrectomy, Data Reveal
Can a regional block technique improve pain control and minimize opioid use after open nephrectomy? Effective postoperative analgesia remains a major challenge, especially when balancing opioid side effects with the need for adequate pain relief. A recent randomized trial in BMC Anesthesiology compares two ultrasound-guided blocks—external oblique intercostal plane block (EOIPB) and posterior transversus abdominis plane block (TAPB)—to determine which provides better outcomes for adult patients after open nephrectomy.
Study Design: Direct Comparison of Two Modern Regional Blocks
This prospective, randomized trial included 40 adults scheduled for elective open nephrectomy. Participants were assigned to receive either EOIPB or TAPB using 20 mL of 0.5% bupivacaine after anesthesia induction. The primary outcome was total opioid (pethidine) use in the first 24 hours. Secondary outcomes included pain scores at prespecified intervals, time to first rescue analgesia, intraoperative fentanyl requirements, adverse events, and patient satisfaction.
Findings: EOIPB Delivers Superior Early Analgesia and Opioid-Sparing Benefit
Pain Scores: EOIPB resulted in significantly lower pain scores at 4, 8, 12, and 18 hours postoperatively compared to TAPB, with the most notable differences meeting clinical significance.
Opioid Use: Patients in the EOIPB group used substantially less pethidine in the first 24 hours (61.5±24.8 mg vs. 114±12.3 mg for TAPB, p<0.001).
Time to Rescue Analgesia: The EOIPB group went longer before needing additional pain medication (7.25±0.91 h vs. 6.1±1.55 h, p=0.007).
Safety: Both techniques showed similar rates of adverse events (bradycardia, hypotension, PONV) and no cases of respiratory depression.
Patient Satisfaction: Satisfaction scores were significantly higher with EOIPB.
Clinical Implications: Why These Results Matter
This study highlights the added value of EOIPB as part of a multimodal analgesia strategy for open nephrectomy. Opioid-sparing effects are particularly relevant given the risks associated with opioid use, including respiratory depression and postoperative nausea and vomiting. The extended duration of pain relief and higher patient satisfaction with EOIPB may enhance recovery protocols and improve patient outcomes. Both techniques appear safe, but EOIPB offers an edge in early postoperative pain management.
Limitations and Future Directions
The single-center design and small sample size limit generalizability, and blocks were performed after induction of general anesthesia, precluding real-time assessment of block success. Larger, multicenter studies are needed to confirm these findings and assess long-term benefits.
Conclusion
Ultrasound-guided EOIPB provides more effective early analgesia, reduces opioid requirements, and increases patient satisfaction compared to TAPB after open nephrectomy. These results support the inclusion of EOIPB in enhanced recovery pathways for abdominal surgery.
Key points
EOIPB provides better early postoperative pain control than TAPB after open nephrectomy.
Patients receiving EOIPB use significantly less opioid in the first 24 hours after surgery.
EOIPB extends the time before first rescue analgesia is needed.
Both blocks have similar safety profiles with low adverse event rates.
Patient satisfaction is higher with EOIPB, supporting its role in multimodal analgesia.
Citation:
Elshikh A, Ali LS, ElSharkawy MS, Fathy SM, Mohamed BG, Hamama K, Elmohasseb MA, Abu Shanab EH, Ragab ZT, Moharam SA, Mady AF. Ultrasound guided external oblique intercostal plane block versus posterior transversus abdominis plane block for postoperative analgesia in adult patients undergoing open nephrectomy: a randomized trial. BMC Anesthesiology. 2026;26:402. https://doi.org/10.1186/s12871-026-03935-4
