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Abstract
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Background and Aims The recently described external oblique intercostal (EOI) plane block might be a good alternative to neuraxial analgesia for upper abdominal incisions, since it is a superficial nerve block that can be performed in the supine position and has easily identifiable ultrasound points, providing upper midline and lateral abdominal wall analgesia.
Methods A 57-year-old female patient, ASA-PS III, presenting with left emphysematous pyelonephritis, was submitted to urgent left total nephrectomy through an oblique subcostal incision. The surgery was performed under general anaesthesia combined with an ultrasound-guided injection of 20 mL of levobupivacaine 0.25% (50mg) and dexamethasone 4mg in the EOI fascial plane. Multimodal Intravenous analgesia with paracetamol 1g and tramadol 100mg were also administrated.
Results Before emergence from anaesthesia, a catheter in the EOI plane was placed and 20mL of ropivacaine 0.2% (40mg) was given. Upon awakening, the patient reported no pain. The postoperative pain management regimen involved intravenous paracetamol 1g every 8 hours and 20ml of ropivacaine 0.2% (40mg) through the EOI plane catheter every 4 hours. No additional analgesia was required.
Patient consent
External Oblique Intercostal Block
External Oblique Intercostal Block
Conclusions The EOI plane block shows promising results in targeting upper abdominal wall analgesia, an anatomic region not sufficiently addressed by other fascial plane blocks, such as the subcostal Transversus Abdominis Plane block or the Rectus Sheath block.