Anesth Pain Med.  2024 Jul;19(3):247-255. 10.17085/apm.24002.

Comparison of analgesic efficacy of combined external oblique intercostal and rectus sheath block with local infiltration analgesia at port site in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial

• Gangadhar V
• Gupta A
• Saini S

• KMID: 2563565
• DOI: http://doi.org/10.17085/apm.24002

Abstract

Background
Conventional fascial plane block approaches for upper abdominal surgeries spare the lateral cutaneous nerve. An external oblique intercostal block (EOIB) may be suitable for upper abdominal incisions as it blocks the lateral and anterior branches of the intercostal nerves T6–T10. However, there is a paucity of studies evaluating this block in clinical settings. The study aimed to compare the analgesic efficacy of combined EOIB and rectus sheath block with local infiltration analgesia (LIA) in laparoscopic cholecystectomy (LC). Methods: After obtaining written informed consent, 70 patients were randomly allocated to undergo right-sided EOIB with 20 ml and left-sided RSB with 10 ml of 0.25% bupivacaine at the end of surgery (group ER, n = 35). Patients in the LIA group (n = 35) underwent local infiltration at the port site using 20 ml of the same solution (group LIA, n=35). Results: The visual analog scale scores with combined EOI and RSB were significantly lower than those with LIA at 1, 2, 4, 8, and 12 h (P < 0.001). Rescue analgesics were required by 65.7% and 14.3% of the patients in the LIA and block groups, respectively (P < 0.001). The time to first rescue analgesic was significantly greater in the ER group than that in the LIA group (2.8 ± 1.10 vs. 1.6 ± 0.50 h; P = 0.012). The number of times rescue analgesia was required was significantly lower in the ER group than that in the LIA group (1.00 ± 0.00 vs. 1.83 ± 0.72; P = 0.015). Nausea and vomiting scores were higher in the LIA group than those in the ER group (P < 0.001). Patient satisfaction scores were higher in the ER group than those in the LIA group. Conclusions: EOIB combined with RSB provides superior analgesia compared with LIA and should be considered for LC.

Keyword

Analgesia; Anesthesia; Local; Bupivacaine; Cholecystectomy; Laparoscopic; Intercostal nerve; Nerve block; Postoperative pain; Patient satisfaction; Rectus sheath block

Figure

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  Fig. 1. Ultrasound-guided external oblique intercostal block. (A) Needling technique. (B) Labeled image. R7: seventh rib, LA: local anesthetic, IM: intercostal muscles, R6: sixth rib, yellow line: pleura, dotted green line: needle trajectory.

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  Fig. 2. Rectus sheath block. (A) Needling technique. (B) Labeled image. N: block needle, RM: rectus muscle, PRS: posterior rectus sheath. LA: local anesthetic deposited between RM and PRS.

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  Fig. 3. Port placement.

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  Fig. 4. Consort diagram.

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  Fig. 5. Graph depicting association between intervention and mean VAS scores at 1 h. VAS: visual analog scale, LIA: local infiltration analgesia.

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  Fig. 6. Graph depicting association between intervention and mean VAS scores at different time intervals. VAS: visual analog scale, LIA: local infiltration analgesia.

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