Comparison between External Oblique Intercostal Plane (EOI) Block and Incisional Local Infiltration Effect in Open Cholecystectomy: A Randomized Controlled Trial
Abstract
Objective: To compare 24-hour postoperative opioid consumption, converted to intravenous morphine equivalents, between patients receiving external oblique intercostal plane (EOI) block and those receiving incisional local infiltration (LA) in open cholecystectomy. Primary outcome: 24-h morphine equivalents. Secondary: pain intensity on a 0–10 numeric rating scale (NRS). The minimal clinically important difference (MCID) was defined as ≥30% opioid reduction and ≥1-point NRS decrease.
Material and Methods: Forty-four patients undergoing open cholecystectomy were randomized to EOI or LA (22 each). The EOI group received 20 mL of 0.25% bupivacaine for EOI block after skin closure, and the LA group received the same dose for local infiltration before skin closure.
Results: For the primary outcome, 24-h morphine equivalent consumption showed no significant difference between the groups (–4.09 mg; p-value=0.058). Ward opioid use (2–24 h) was lower in the EOI group (10.2±5.3 mg) than the LA group (14.1±6.9 mg); mean difference –3.96 mg, 95% CI (–7.69 to –0.22), p-value=0.038. This 28% reduction did not meet the 30% MCID. Median movement NRS in the ward was significantly lower with EOI (6 [IQR 5–6]) than LA (7 [IQR 5.75–8]); median difference –1, 95% CI (–2.00 to 0.00), p-value=0.022, meeting the 1-point MCID.
Conclusion: Although the EOI block did not significantly reduce total 24-hour morphine consumption, it was associated with a clinically meaningful reduction in movement-evoked pain.
Keywords
Full Text:
PDFReferences
Helden EV, Kranendonk J, Vermulst A, Boer AD, Reuver PD, Rosman C, et al. Early postoperative pain and 30-day complications following major abdominal surgery: a retrospective cohort study. Reg Anesth Pain Med 2025;50:651-657. doi: 10.1136/rapm-2024-105277.
Kunapaisal T, Pattaravit N, Thongsuksai P. Factors associated with moderate to severe pain after laparoscopic surgery. J Health Sci Med Res 2021;39:365–72. doi:10.31584/jhsmr.2021792.
Baeriswyl M, Kirkham KR, Kern C, Albrecht E. The analgesic efficacy of ultrasound-guided transversus abdominis plane block in adult patients: a meta-analysis. Anesth Analg 2015;121:1640-54.
doi: 10.1213/ANE.0000000000000967.
Ghosh A, Ninave S. Navigating pain relief: a comprehensive review of transversus abdominis plane block. Cureus 2023;15:e51119. doi: 10.7759/cureus.51119.
Viderman D, Aubakirova M, Abdildin YG. Erector spinae plane block in abdominal surgery: a meta-analysis. Front Med 2022;9:812531.
doi: 10.3389/fmed.2022.812531.
Hymes-Green Z, LaGrone EL, Peabody Lever JE, Feinstein J, Piennette PD, Lawson P, et al. Efficacy of erector spinae plane (ESP) block for non-cardiac thoracic and upper abdominal surgery: a single institute comparative retrospective case series. Cureus 2024;16:e58926. doi: 10.7759/cureus.58926.
Farooq M, Carey M. A case of liver trauma with a blunt regional anesthesia needle while performing transversus abdominis plane block. Reg Anesth Pain Med 2008;33:274-5. doi: 10.1016/j.rapm.2007.11.009.
Lancaster P, Chadwick M. Liver trauma secondary to ultrasound-guided transversus abdominis plane block. Br J Anaesth 2010;104:509–10. doi: 10.1093/bja/aeq046.
Hang D, Weich D, Anderson C, Dolinski SY. Severe abdominal wall infection after subcostal transversus abdominis plane block: a case report. A A Pract 2021;15: e01531. doi: 10.1213/XAA.0000000000001531.
Støving K, Rothe C, Rosenstock CV, Aasvang EK, Lundstrøm LH, Lange KHW. Cutaneous sensory block area, muscle-relaxing effect, and block duration of the transversus abdominis plane block: a randomized, blinded, and placebo-controlled study in healthy volunteers. Reg Anesth Pain Med 2015;40:35.
doi: 10.1097/AAP.0000000000000252.
Guna Pratheep K, Sonawane K, Rajasekaran S, Shetty AP, Subramanian BJ, Kanna RM. Transient paraplegia in lumbar spine surgery—a potential complication following erector spinae plane block. Eur Spine J 2022;3:3719–23. doi: 10.1007/s00586-021-07059-w.
Hamilton DL, Manickam BP, Wilson MAJ, Abdel Meguid E. External oblique fascial plane block. Reg Anesth Pain Med 2019 ;44:528–9.
doi: 10.1136/rapm-2018-100256.
Elsharkawy H, Kolli S, Soliman LM, Seif J, Drake RL, Mariano ER, et al. The external oblique intercostal block: anatomic evaluation and case series. Pain Med 2021;22:2436–42. doi: 10.1093/pm/pnab296.
Ohgoshi Y, Kawagoe I, Ando A, Ikegami M, Hanai S, Ichimura K. Novel external oblique muscle plane block for blockade of the lateral abdominal wall: a pilot study on volunteers. Can J Anesth/J Can Anesth 2022;69:1203–10. doi: 10.1007/s12630-022-02310-4.
Amaral S, Medeiros H, Lombardi R, Bandeira M, Silva WA da, Pawa A. EP074 Enhancing analgesia for a kocher incision: incorporating external oblique intercostal block in multimodal analgesia – a case series. Reg Anesth Pain Med 2023;48(Suppl 1):A79. doi: 10.1136/rapm-2023-ESRA.136.
White L, Ji A. External oblique intercostal plane block for upper abdominal surgery: use in obese patients. Br J Anaesth 2022;128:
e295–7. doi: 10.1016/j.bja.2022.02.011.
Korkusuz M, Basaran B, Et T, Bilge A, Yarimoglu R, Yildirim H. Bilateral external oblique intercostal plane block (EOIPB) in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial. Saudi Med J 2023;44:1037–46.
doi: 10.15537/smj.2023.44.10.20230350.
Krebs EE, Carey TS, Weinberger M. Accuracy of the pain numeric rating scale as a screening test in primary care. J Gen Intern Med 2007;22:1453–8. doi: 10.1007/s11606-007-0321-2.
Mansoor A, Ellwood S, Hoffman G, Scholer A, Gore A, Grech D, et al. The efficacy and safety of transversus abdominis plane blocks after open cholecystectomy in low- and middle-income countries. J Surg Res 2020;256:136–42. doi: 10.1016/j.jss.2020.06.020.
Laigaard J, Pedersen C, Rønsbo TN, Mathiesen O, Karlsen APH. Minimal clinically important differences in randomised clinical trials on pain management after total hip and knee arthroplasty: a systematic review. Br J Anaesth 2021;126:1029-37. doi: 10.1016/j.bja.2021.01.021.
Myles PS, Myles DB, Galagher W, Boyd D, Chew C, MacDonald N, Dennis A. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. Br J Anaesth. 2017;118:424-9. doi: 10.1093/bja/aew466.
Boulianne M, Verret M, O’Connor S, Savard X, Neveu X, Marcoux C, et al. Comparative effectiveness of analgesic techniques for abdominal surgery: a network meta-analysis. BMC Anesth 2025;25:105. doi: 10.1186/s12871-025-03105-y.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.