Background and Aims External oblique fascial plane block (EOIB) is a relatively new block that targets both anterior and lateral cutaneous branches of the thoracoabdominal nerves by injecting the local anesthetic between the external oblique and intercostal muscles. Multiple indications have been described to perform EOIB. Here, we aimed to report using EOIB as a rescue analgesia method for laparoscopic (L/S) upper abdominal surgeries.
Methods Although the multimodal analgesia regimen was applied during the surgery, the pain status of patients with NRS score > six was defined as “unbearable” and EOIB was performed over the 6th and 7th ribs as rescue analgesia in the postoperative care unit (PACU). Our cases were laparoscopic (L/S) cholecystectomy (2 patients), L/S sleeve gastrectomy, L/S Nissen fundoplication, and L/S hiatal hernia repair. Ultrasound (US) guided EOIB was performed with 25 ml of the local anesthetic mixture (bupivacaine 0.5%, 10 ml lidocaine 2%, and 15 ml saline) for each side. Pain scores and bilateral sensorial examination were recorded over time.
Results NRS scores dropped below “3” in approximately 30 minutes. A cutaneous sensory block occurred between T6-T10 and T5-T10 in the mid-abdomen and anterior axillary lines, respectively (Table 1).
Conclusions EOIB may be an option as rescue analgesia in L/S upper abdominal surgeries in cases where multimodal analgesia is insufficient. US-guided EOIB is superficial and easy to perform; the related ribs act as an anatomical barrier.
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