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EP074 Enhancing analgesia for a kocher incision: incorporating external oblique intercostal block in multimodal analgesia – a case series
  1. Sara Amaral1,
  2. Heitor Medeiros2,
  3. Rafael Lombardi3,
  4. Marcelo Bandeira4,
  5. Wallace Andrino da Silva2 and
  6. Amit Pawa5
  1. 1Anaesthesiology, , Araranguá, Brazil
  2. 2Anaesthesiology, Hospital Universitário Onofre Lopes, Natal, Brazil
  3. 3Anaesthesiology, University of Nebraska Medical Center, Omaha, USA
  4. 4Anaesthesiology, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
  5. 5Anaesthesiology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK


Background and Aims The External Oblique Intercostal block (EOIB) provides analgesia to the upper midline and upper lateral abdominal wall. This study assesses the efficacy of this block in patients undergoing cholecystectomy with a right subcostal incision.

Methods We describe fourteen elective open cholecystectomy cases where a right external oblique intercostal plane block (EOIB) was performed with 30mL of 0.33% ropivacaine after the induction of general anesthesia. During surgery, all patients received 3µg/kg of Fentanyl and an additional 50µg bolus as needed, 30mg/kg Metamizole, and 100mg Ketoprofen. For postoperative nausea and vomiting (PONV) prophylaxis, Ondansetron 0.15mg/kg and Dexamethasone 0.15mg/kg were administered. Postoperative analgesia was maintained with 1g IV Metamizole 8/8h. Opioid consumption, complications, and patient satisfaction with analgesia were recorded within the first 24h. Demographics and intraoperative profiles were collected (table 1). Consent was obtained from all patients.

Abstract EP074 Table 1

Demographic profile and intra and postoperative characteristics

Abstract EP074 Table 2

Pain scores using VAS within the first 24 hours postoperatively

Abstract EP074 Figure 1

External oblique intercostal plane block illustration and ultrasound image

Results Upon PACU admission, over 75% of patients had a VAS of less than 3, and the highest pain score was observed at 12 and 24 hours postoperatively, which corresponds to the block’s analgesia duration (table 2). The postoperative opioid consumption was relatively low overall with only 4 patients requiring one time use of Tramadol 100mg IV. Patient satisfaction with analgesia was high, as indicated by 70% of patients providing a satisfaction score of 10/10. No cases of PONV or block-related complications were observed.

Conclusions Our findings suggest that EOIB reduces pain scores and opioid consumption for Kocher surgeries and is an effective part of a multimodal analgesia strategy

  • fascial plane blocks
  • external oblique intercostal block
  • multimodal analgesia
  • kocher incision
  • cholecystectomy

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