Analgesic efficacy of external oblique intercostal plane block in paediatric patients undergoing upper abdominal...

The external oblique intercostal (EOI) plane block is a new interfascial plane block covering both the lateral and anterior cutaneous branches of the intercostal nerves. The literature on its use is scarce in paediatric abdominal surgeries.

Forty American Society of Anesthesiologists physical status I/II patients aged between 2 months and 7 years undergoing upper abdominal surgery with unilateral subcostal incision were randomised: Group E received an ultrasound guided unilateral EOI block using 0.5 mL/kg of 0.2% ropivacaine with general anaesthesia, whereas Group C received general anaesthesia (GA) only. All patients received GA in a standardised manner. Any increase in heart rate or mean arterial pressure of more than 20% was treated with intravenous (IV) fentanyl 0.5 µg/kg. Postoperatively, tramadol 1 mg/kg IV was given as rescue analgesia if the pain score was ≥4. The study's primary outcome was to assess the intraoperative fentanyl consumption. Secondary outcomes included postoperative pain score at 1, 4, 8, 16, and 24 h at rest, time to first rescue analgesic administration, 24 h tramadol consumption, and incidence of side effects such as nausea and vomiting. P <0.05 were considered statistically significant.

The mean intraoperative fentanyl consumption was lower in Group E: 12 [standard deviation (SD: 10.1] [95% confidence interval (CI): 7.3, 16.7] µg as compared to Group C: 20.5 (8.35) [95% CI: 16.7, 24.3] µg (P = 0.005). Total mean 24 h tramadol consumption was statistically lower in Group E: 29.3 (SD: 12.5) [95% CI: 23.4, 35.2] mg vs 62.1 (SD: 19.7) [95% CI: 52.9, 71.3] (P < 0.001). Pain scores were lower in Group E at 1, 4, 8, 16, and 24 h.

The single-shot EOI block can decrease perioperative opioid requirement and pain score. It can form an integral part of a multimodal analgesic regime for upper abdominal surgeries in paediatric patients.