Analgesic efficacy of external oblique intercostal block in laparoscopic surgery: a systematic review and...

The external oblique intercostal block (EOIB) is a novel regional anesthesia technique targeting the anterior and lateral branches of the lower thoracoabdominal nerves (T6-T10). It has gained popularity for upper abdominal laparoscopic procedures, but its overall efficacy remains to be quantified. We performed a systematic review and meta-analysis to evaluate the analgesic efficacy and safety of EOIB in laparoscopic surgery.

Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL for randomized controlled trials (RCTs) comparing EOIB with no block, systemic analgesia, local anesthetic infiltration (LI), or other regional techniques in adults undergoing laparoscopic surgery. The primary outcome was 24-hour cumulative opioid consumption. Secondary outcomes included postoperative pain scores (at rest and during movement, at early [0-6 hours] and late [12-24 hours] intervals), time to first rescue analgesia, quality of recovery (QoR-15), and adverse events.

EOIB significantly reduced 24-hour opioid consumption compared to control groups (SMD: -1.12; 95% CI: -2.22 to -0.02; P=0.0467), with the greatest opioid-sparing effect observed when EOIB was compared to no block or LI. Postoperative pain scores at rest and during movement were significantly lower in the EOIB group compared to control groups at 6, 12, and 24 hours after surgery. There were no statistically significant differences between the EOIB and control groups in terms of time to first analgesic request, QoR-15 scores, or the incidence of adverse events.

EOIB offers effective postoperative analgesia in laparoscopic surgery, reducing pain for up to 24 hours and decreasing opioid requirements without increasing adverse events. High-quality RCTs with standardized techniques and extended follow-up are needed to clarify its optimal perioperative role.