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Background and Aims In patients undergoing liver transplantation, postoperative pain control can be challenging since a neuraxial block is contraindicated with ongoing coagulopathy. This led us to investigate the utility of ultrasound-guided external oblique intercostal (EOI) blocks in this patient population. Local anesthetic is injected in the fascial plane between the external oblique and intercostal muscle at the T6 and T8 levels, bilaterally, for somatic coverage of the ‘chevron’ incision. Here, we present a small comparative case series.
Methods This is a retrospective chart review comparing the postoperative opioid utilization of five patients with and without the EOI block.
Results The average oral morphine equivalents (OME) for POD 0, 1, 2, and 3 were 39mg, 70.5mg, 28.4mg, and 12.3mg in the EOI group and 71.8mg, 109.1mg, 85.5mg, and 53.5mg in the control group (table 1).
Conclusions 30ml of 0.25% bupivacaine mixed with 20ml of liposomal bupivacaine was used and 12.5ml of this mixture was injected at each level. The average OME for each postoperative day was higher in the control group compared to the EOI group. The average OME values in the control group were close to double on POD 0 and 1 and more than doubled on POD 2 and 3 compared to EOI group. The EOI block made a clinically significant difference in our patients’ opioid usage and overall satisfaction. The EOI block is superficial with reliable sonoanatomy and can be performed in the supine position without interfering with the surgical incision. Most importantly it can be performed in liver transplant patients with ongoing coagulopathy.
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