Enhanced recovery with bilateral external oblique intercostal block in elderly patients undergoing extensive...

Postoperative pain management after major upper abdominal surgery remains challenging. Thoracic epidural analgesia, whilst the gold standard, carries significant risks especially in elderly or coagulopathic patients post-operatively. The external oblique intercostal (EOI) block is a novel regional technique providing somatic upper abdominal wall analgesia without sympathetic blockade or motor impairment. We report two cases where bilateral EOI catheters facilitated effective analgesia after extensive upper abdominal surgery, including distal pancreatectomy in an 87-year-old, and left hepatectomy in a 67-year-old. Both patients were able to ambulate early and required minimal systemic analgesia, supporting the EOI block's role within enhanced recovery protocols.