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Background
Providing analgesia after bariatric surgery might be challenging due to a high prevalence of obstructive sleep apnea syndrome and the increased sensitivity to respiratory depression triggered by opioid overuse after surgery. Various combination methods with paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and other pain medica...
Similar publications
Pediatric orthopaedic surgical procedures require a thoughtful multimodal approach to perioperative pain management that maximizes both patient comfort and safety. Local infiltrative anesthesia (LIA) has been commonly used with a variety of formulations and application methods. However, local anesthesia provides limited anatomic coverage over a rel...
Citations
... To date, the postoperative efficacy of EOI block has been reported in few publications [11][12][13], and the literature related to patients with obesity is limited to case reports and case series [6,14,15]. In a retrospective cohort study, EOI block was administered to 15 of 74 patients undergoing bariatric surgery under regional anesthesia. ...
... In a retrospective cohort study, EOI block was administered to 15 of 74 patients undergoing bariatric surgery under regional anesthesia. It was reported that similar to TAP and rectus sheath blocks, the EOI block reduced opioid consumption in the first 24 h postoperatively compared to patients who did not receive any block [15]. There are also a few case reports that have demonstrated the potential utility of the EOI block in providing effective postoperative analgesia in patients with obesity [6,14]. ...
Purpose
The external oblique intercostal plane (EOI) block is a novel block technique for anterolateral upper abdominal wall analgesia. The superficial nature of the external oblique intercostal plane allows it to be easily identified even in patients with obesity. The aim of this study was to test the hypothesis that EOI block would reduce IV morphine consumption within 24 h after laparoscopic sleeve gastrectomy.
Materials and Methods
Patients were randomly assigned to one of two groups: EOI block group and control group. The patients in the EOI block group received ultrasound-guided bilateral EOI block with a total of 40 ml 0.25% bupivacaine after anesthesia induction. The patients in the control group received no intervention. Postoperatively, all the patients were connected to an intravenous patient controlled analgesia (PCA) device containing morphine. The primary outcome of the study was IV morphine consumption in the first postoperative 24 h.
Results
The median [interquartile range] morphine consumption at 24 h postoperatively was significantly lower in the EOI block group than in the control group (7.5 [3.5 to 8.5] mg vs 14 [12 to 20] mg, p = 0.0001, respectively). Numerical rating scale (NRS) scores at rest and during movement were lower in the EOI block group than in the control group at 2, 6, and 12 h but were similar at 24 h. No block-related complications were observed in any patients.
Conclusion
The results of the current study demonstrated that bilateral EOI block reduced postoperative opioid consumption and postoperative pain in patients with obesity undergoing laparoscopic sleeve gastrectomy.
Trial Registration
Clinicaltrials.gov identifier: NCT05663658.
Graphical Abstract
... 1 EOIB has many advantages such as easy sonoanatomy, superficial location at a compressible site, easily performed in obese patients, needle insertion site is away from the surgical site, can be performed in the supine position, no anticoagulation concern, technical simplicity, and ease of catheter placement. 10,11 The rib acts as a protective barrier against inadvertent pneumothorax. By cadaveric dye study, they found that the lateral and anterior cutaneous nerves from T6/7 to T10/11 are covered and can be used for upper abdominal wall analgesia (Figures 1-3) It lacks visceral or sympathetic blockade, making multimodal analgesia necessary. ...
Open nephrectomy is a common surgery usually performed for malignant and non-malignant renal pathologies. The external oblique intercostal block (EOIB) blocks the anterior and lateral cutaneous nerves from T6 to T10 and provides somatic analgesia. We present a case series of the use of EOIB in patients undergoing open nephrectomy by subcostal incision. Ten patients were given EOIB, which included patients undergoing simple nephrectomy for non-functioning kidneys and radical nephrectomy for renal mass. The patients had satisfactory numerical rating scale scores, mostly <4 for 24 h. Post-operative opioid consumption was minimal. The external oblique fascial plain block is a novel thoracic block that provides reliable upper thoracoabdominal somatic analgesia. It can certainly be considered a suitable option in surgeries such as nephrectomies that involve an upper lateral abdominal wall incision.
... Desafortunadamente, no mencionan una modalidad de analgesia regional específica con impacto en el ahorro de opioides y calidad analgésica (2) . Sin embargo, los bloqueos de fascia guiados por ultrasonido han demostrado eficacia en el manejo del dolor agudo postoperatorio en esta población (3) . El bloqueo del plano transverso abdominal (TAP) es la intervención más utilizada en pacientes sometidos a cirugías bariátricas, los reportes lo compararon con el bloqueo del erector espinal guiado por ultrasonido (ESPB UG) bilateral. ...
... With the EOI block, patients should experience consistent sensory blockade of T6 to T9 at the midline and T6 to T10 at the anterior axillary line [75]. This technique has been shown to be effective in bariatric and liver surgery with patients having reduced opioid consumption and improved postoperative pain scores [77][78][79]. ...
Careful perioperative pain management is crucial for good patient outcomes after surgery, as poorly controlled pain interferes with the ability of patients to recover to normal baseline function and increases postoperative morbidity and mortality. Although opioids have been the mainstay for treating postoperative pain, there has been a shift in favor of a multimodal analgesic approach, including regional anesthesia, as a way to circumvent opioid-related adverse events (e.g. nausea and vomiting, respiratory depression, sedation). In this chapter, we present an update on several recently developed regional anesthetic techniques, local anesthetic medications, as well as nerve block adjuncts with the potential to improve pain management in the perioperative setting. With more future studies, these novel methods may be incorporated into postsurgical recovery protocols and provide the opportunity to improve patient outcomes.
... In that study, EOIPB was applied to 15 patients using 30 ml 0.25% bupivacaine and it was reported that the TAP+RB (rectus sheath block), ESPB, and EOIPB that were used in the study all decreased morphine consumption, but the TAP+RB and EOIPB seemed to be the most effective blocks. 25 Based on the findings of the current investigation, although tramadol consumption was statistically lower at postoperative 24 hours compared to the control group, it did not reach a level of minimal clinically important difference. 17 Fascial plane blocks' contribution to visceral analgesia is less effective than the somatic part. ...
... Cadaver studies have used a volume of 15 ml and a retrospective study used 30 ml (0.25%) bupivacaine for one side of the blockade. 8, 25 White and Ji 13 placed catheters in the EOI plane and injected 20 ml of 0.2% ropivacaine and 40 ml of 0.5% ropivacaine. In the present study, 25 ml (0.25%) bupivacaine was used for each side. ...
Objectives: To measure tramadol intake in the first 24
hours post-surgery. In addition, pain scores and quality
of recovery were evaluated as secondary outcomes.
Methods: A total of 80 adult patients scheduled for
laparoscopic cholecystectomy were randomized into 2
groups (with and without external oblique intercostal
plane block [EOIPB]). Control group of patients
received standard multimodal analgesia, EOIPB was
applied on each side to patients in EOIPB group in
addition to multimodal analgesia. The primary outcome
was to evaluate tramadol consumption at postoperative
24 hours. Secondary outcomes were evaluating the
Numeric Rating Scale (NRS) scores, postoperative
Original Article
Quality of Recovery score (QoR-15), sedation score,
the incidence of nausea and vomiting, and antiemetic
consumption.
Results: In EOIPB group, median (Q1, Q3) tramadol
consumption values for 24 hours (0 [0,50] mg) were
found to be significantly lower than the control group
(50 [50,100] mg) (median difference -50) (p<0.001).
NRS values during rest and motion were lower in
EOIPB group compared to the control group at all
measurement points within 24 hours (p<0.05). The total
QoR-15 scores were significantly higher in EOIPB group
compared to the control group (p<0.001). No differences
were detected in other secondary outcome parameters.
Conclusion: External oblique intercostal plane block
resulted in less postoperative tramadol consumption.
However, there were no minimal clinically important
differences about postoperative opioid consumption.
On the other hand, compared to multimodal analgesia
addition of EOIPB improved overall QoR-15 scores at
postoperative 24 hours.
Clinical Trial Reg. No.: NCT05536557
... The review also mentioned a retrospective cohort study on 120 laparoscopic bariatric surgery patients, 74 of whom received regional anesthesia. Fifteen of these 74 patients received external oblique intercostal blocks, and postoperative opioid consumption for these 15 patients was similar to that of patients who received rectus sheath or TAP blocks [59]. ...
Purpose of review:
The purpose of this review is to provide an up-to-date description and overview of the rapidly growing literature pertaining to techniques and clinical applications of chest wall and abdominal fascial plane blocks in managing perioperative pain.
Recent findings:
Clinical evidence suggests that regional anesthesia blocks, including fascial plane blocks, such as pectoralis, serratus, erector spinae, transversus abdominis, and quadratus lumborum blocks, are effective in providing analgesia for various surgical procedures and have more desirable side effect profile when compared to traditional neuraxial techniques. They offer advantages such as reduced opioid consumption, improved pain control, and decreased opioid-related side effects. Further research is needed to establish optimal techniques and indications for these blocks. Presently, they are a vital instrument in a gamut of multimodal analgesia options, especially when there are contraindications to neuraxial or para-neuraxial procedures. Ultimately, clinical judgment and provider skill set determine which blocks-alone or in combination-should be offered to any patient.
... In a previous study that investigated the feasibility and effectiveness of ESPB against transversus abdominis plane (TAP) block in bariatric surgery, it was reported that ESPB showed a better analgesic effect with lower postoperative opioid consumption compared to TAP block [47]. In a retrospective study that compared facial plane blocks such as ESPB, TAP block, and the combination of rectus sheath block and external oblique block in bariatric surgery, it was reported that ESPB led to a decreased opioid use, but did not show superiority over other blocks [48]. ...
Background
Postoperative pain management after bariatric surgery is difficult due to different physiological properties and high sensitivity toward opioids in patients with obesity. It has been reported that erector spinae plane block (ESPB) contributes to postoperative analgesia when applied together with multimodal analgesia.
Methods
Eighty patients were randomized either bilateral ESPB (group E) each side or no block (group C). Our primary aim was to evaluate the effects of ESPB on the quality of recovery 24 h postoperatively in bariatric surgery by using 40-item Quality of Recovery-40 (QoR-40) questionnaire. Postoperative pain assessed using a numerical rating scale (NRS), time of additional analgesic requirement, analgesic consumption, side effects, sedation, mobilization time, and postoperative complications were evaluated as secondary outcomes.
Results
Postoperative mean QoR-40 scores were found to be higher in group E (175.02 ± 11.25) than in group C (167.78 ± 18.59) at the postoperative 24th hour (P < 0.05). Pain scores at rest and during movement were higher in group C than in group E. At the postoperative 24th hour, NRS mean SD scores at rest for group C and group E were 3.25 ± 1.32 and 2.40 ± 0.96, respectively. NRS mean SD scores during movement for groups C and E were 3.88 ± 1.49 and 3.12 ± 1.30, respectively. The total amount of tramadol consumed in the first 24 h in group C and group E were mean SD: 86.40 ± 69.60 and 40.00 ± 46.96, respectively; P < 0.05.
Conclusions
ESPB improved postoperative quality of recovery, reduced NRS scores, and total analgesic consumption in patients with obesity undergoing bariatric surgery.
Clinical Trial Registration
NCT05020379.
Graphical Abstract
... The EOI plane block is a superficial plane technique that likely has a low risk profile similar to that of the erector spinae plane block (ESPB) [2]. To date, there are only four studies describing the technique covering a cohort of 40 patients utilizing either single shot or catheter based techniques [3][4][5][6]. ...
... Of the 23 catheters which tested for dermatomal distribution, all provided coverage from the posterior axillary line laterally to the In addition to analgesic efficacy, Coşarcan et al. and White et al. also noted the anatomical advantage of accessing the EOI plane compared to traditional plane blocks in obese patients [5,6]. In a retrospective cohort study of patients undergoing laparoscopic bariatric surgery, Coşarcan noted that the EOI plane block technique provided a statistically significant reduction in opioid use in the first 24 h post-operatively compared to anaesthetics without regional techniques. ...
... The EOI plane block is a superficial plane technique that likely has a low risk profile similar to that of the erector spinae plane block (ESPB) [2]. To date, there are only four studies describing the technique covering a cohort of 40 patients utilizing either single shot or catheter based techniques [3][4][5][6]. ...
... Of the 23 catheters which tested for dermatomal distribution, all provided coverage from the posterior axillary line laterally to the In addition to analgesic efficacy, Coşarcan et al. and White et al. also noted the anatomical advantage of accessing the EOI plane compared to traditional plane blocks in obese patients [5,6]. In a retrospective cohort study of patients undergoing laparoscopic bariatric surgery, Coşarcan noted that the EOI plane block technique provided a statistically significant reduction in opioid use in the first 24 h post-operatively compared to anaesthetics without regional techniques. ...
