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The External Oblique Intercostal Block: Anatomic Evaluation and Case Series
Hesham Elsharkawy1,2, Sree Kolli3, Loran Mounir Soliman3
1Department of Anesthesiology, Pain and Healing Center, MetroHealth, Case Western Reserve University, Cleveland, Ohio, USA.
Study Objective:
We report a modified block technique aimed at obtaining upper midline and lateral abdominal wall analgesia: the external oblique intercostal (EOI) block.
Design:
A cadaveric study and retrospective cohort study assessing the potential analgesic effect of the EOI block.
Setting:
Cadaver lab and operating room.
Patients:
Two unembalmed cadavers and 22 patients.
Interventions:
Bilateral ultrasound-guided EOI blocks on cadavers with 29 mL of bupivacaine 0.25% with 1 mL of India ink; single-injection or continuous EOI blocks in patients.
Measurements:
Dye spread in cadavers and loss of cutaneous sensation in patients.
Main Results:
In the cadaveric specimens, we identified consistent staining of both lateral and anterior branches of intercostal nerves from T7 to T10. We also found consistent dermatomal sensory blockade of T6-T10 at the anterior axillary line and T6-T9 at the midline in patients receiving the EOI block.
Conclusions:
We demonstrate the potential mechanism of this technique with a cadaveric study that shows consistent staining of both lateral and anterior branches of intercostal nerves T7-T10. Patients who received this block exhibited consistent dermatomal sensory blockade of T6-T10 at the anterior axillary line and T6-T9 at the midline. This block can be used in multiple clinical settings for upper abdominal wall analgesia.
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