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Abstract
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Background and Aims Upper abdominal surgeries with subcostal incisions are a cause of severe pain and can lead to significant respiratory impairment. Neuraxial or regional anaesthesia techniques are method of choice for pain management in these cases but, there are many limitations to it. External oblique intercostal block is a novel fascial plane block which aims to provide upper midline and lateral abdominal wall analgesia thereby reducing perioperative opioid consumption.
Methods We describe case series of five patients who underwent upper abdominal surgeries with subcostal incision. Induction of general anaesthesia was performed with intravenous Fentanyl 2 μg/kg, Propofol 2 mg/kg and Atracurium 0.5 mg/kg.With patient in supine position ultrasound guided External Oblique Intercostal Plane block was performed with 0.5ml/kg of 0.2% Ropivacaine.Intraoperative any increase in HR/MAP more than 20%was treated with additional fentanyl doses of 1mcg/kg.Total intraoperative fentanyl consumption was noted. After skin closure Paracetamol suppository 20mg/kg was given to all the patients.Postoperatively Injection Tramadol 1mg/kg IV was given as rescue analgesia for patients if FLACC score ≥4
Sonoanatomy of external oblique intercostal plane block
Results Mean intraoperative fentanyl consumption was 38±4.52mcg,median FLACC score was 2(1-3)over each time period and mean time for first rescue analgesia was 10±7.2 hours.Total postoperative tramadol consumption was 26±8.34mg.None of the patients developed nausea,vomiting or LAST.
Conclusions EOI block is a promising technique for perioperative analgesia in surgeries with subcostal incision.It offers the advantage of having easily identifiable sonographic landmarks and can be performed with the patient in the supine position.A regional analgesia technique like this would reduce perioperative opioid requirement and enhance early mobilisation and recovery.