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Efficacy of ultrasound-guided external oblique intercostal plane block in laparoscopic common bile duct exploration:
Qianqian Jia1, Lili Zhang1, Yang Han1
1Department of Anesthesiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China.
Background:
Ultrasound-guided external oblique intercostal plane block (EOIPB) is a modified block technique used in the past few years for anterolateral upper abdominal wall analgesia. This study observed the efficacy of EOIPB in laparoscopic common bile duct exploration (LCBDE).
Objectives:
To evaluate the efficacy of EOIPB in patients undergoing LCBDE.
Methods:
Sixty patients undergoing elective LCBDE were randomly assigned to two groups, an EOIPB group and a control group. In the EOIPB group, the patients received ultrasound-guided right EOIPB with a total of 20 mL of 0.5% ropivacaine before anesthesia induction. In the control group, the patients received no intervention before anesthesia induction. The primary outcomes were visual analog scale (VAS) scores within 24 h postoperatively and the number of patient-controlled analgesia (PCA) uses 24 h postoperatively. The secondary outcomes were dermatomal coverage of EOIPB, intraoperative vital signs, the intraoperative dose of remifentanil, and the 24-h postoperative quality of recovery-40 (QoR-40) score of the two groups.
Results:
In the EOI group, VAS scores at rest and movement were significantly lower than in the control group at 30 min, 6 h, and 12 h postoperation (p < 0.05), with no significant difference at 24 h (p > 0.05). The number of PCA uses within 24 h was significantly lower in the EOIPB group (1.60 ± 0.89) compared to the control group (2.50 ± 1.11, p < 0.05). Dermatomal coverage in the EOIPB group achieved 100% T6-T10 at the anterior median and midclavicular lines, 100% T6-T9 at the anterior axillary line, and 93.3% T7-T8 at the posterior axillary line. Mean arterial pressure (MAP) was significantly lower in the EOIPB group at skin incision (T2), 10 min postoperative (T3), and 30 min after extubation (T5) (p < 0.05), and heart rate (HR) was significantly lower at T2 (p < 0.05). The intraoperative remifentanil dose was significantly reduced in the EOIPB group (0.84 ± 0.13 mg) compared to the control group (0.94 ± 0.14 mg, p < 0.05). The EOIPB group had a shorter bedridden time (23.33 ± 2.81 h vs. 25.23 ± 3.64 h, p < 0.05) and a higher QoR-40 score (170.6 ± 5.2 vs. 165.5 ± 6.3, p < 0.05), indicating improved recovery.
Conclusion:
The use of EOIPB in LCBDE can reduce VAS scores and the number of PCA uses 24 h postoperatively. EOIPB also steadied the intraoperative vital signs, reduced the dose of remifentanil, and improved the quality of recovery. EOIPB can be safely and effectively used in LCBDE.
