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Ultrasound guided RA (UGRA)
B28 The external oblique intercostal plane block as part of enhanced recovery after pancreatic surgery: a case series
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  1. D Liotiri1,
  2. A Diamantis2,
  3. E Sioka2,
  4. G Vassia3,
  5. G Stamatiou1 and
  6. D Zacharoulis2,4
  1. 1IASO Thessalias, Department of Anaesthesiology, Larissa, Greece
  2. 2IASO Thessalias, Department of Surgery, Larissa, Greece
  3. 3University of Thessaly, Department of Medicine, Larissa, Greece
  4. 4University of Thessaly, Faculty of Medicine, Larissa, Greece

Abstract

Background and Aims With informed consent, we report our clinical experience with External Oblique Intercostal (EOI) block for a series of four patients who underwent pancreatoduodenectomy. All four patients had their pain well controlled under Thoracic Epidural Analgesia (TEA) for the first 72 hours. When the epidural catheter removed, we sited bilateral EOI catheters as part of a step-down multimodal analgesia approach. EOI block is a recently described fascial plane block which covers the anterior and lateral upper abdominal wall.1

Methods We injected a bolus of 20 ml Ropivacaine 0.375% via each catheter twice a day for the first 48 hours and then once a day for the next 48 hours. We removed the catheters after four days. All patients received Paracetamol 1gr every 8 hours and Gabapentin 300mg at bedtime.

Abstract B28 Figure 1
Abstract B28 Figure 1

EOI block technique

Abstract B28 Figure 2
Abstract B28 Figure 2

Ultrasound anatomy of EOI BlockEO: External Oblique muscle, IC: Intercostal muscle, Pl: Pleura, LA: Local Anaesthetic, Pink arrows indicate needle position

Abstract B28 Figure 3
Abstract B28 Figure 3

Bilateral EOI catheters in-situ for transitional postoperative pain management in a patient who underwent pancreatoduodenectomy

Results All patients remained pain and opioid free and able to mobilise and breath effectively. All patients were very satisfied with analgesia provided by the EOI catheters.

Conclusions With the evolution of regional anaesthesia techniques, the opioid use in acute pain management needs to be re-evaluated.2 We used the EOI block to provide enhanced recovery analgesia3 for pancreatoduodenectomy. We have shown that a regional block could be used for step-down analgesia to avoid opioid use and improve outcomes.

http://dx.doi.org/10.1136/rapm-2022-ESRA.103

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