External oblique intercostal plane block in open hepatobiliary surgery: A case series

Analgesic management in subcostal laparotomy is a challenge, and has a direct impact on recovery and outcomes. The external oblique intercostal (EOI) block anaesthetises the anterior and lateral cutaneous branches of the ventral rami of the intercostal nerves, and both the puncture site and the local anaesthetic target are located outside the surgical field, blocking the anterior and lateral cutaneous branches of the ventral rami of the intercostal nerves.

Observational, retrospective, single-centre study. Patients scheduled for open hepatobiliary surgery under general anaesthesia and intrathecal morphine were included. EOI block was performed before the incision as part of a multimodal analgesia strategy. After anaesthesia induction, with the patient supine, a 12-15 MHz linear transducer was placed over the sixth rib and an 80 mm needle was used to administer 20 ml of 0.25 % levobupivacaine on each side in the case of bilateral incisions or on one side in the case of unilateral incisions.

Fifteen patients scheduled for open hepatectomy, pancreaticoduodenectomy, and open cholecystectomy were included. Pain rated on the visual numerical scale was 0 (0-0) out of a possible 5 (0-5) points on postoperative day 1. Twelve patients (80%) were able to move to a chair on postoperative day 1. Six (40%) required rescue morphine in the first 24 postoperative hours. The average dose administered was 1.4 mg (±2).

Single-shot EOI block is an effective, safe, and easily reproducible technique in a multimodal analgesic approach to major abdominal surgery.