2024 FSA Podium and Poster Abstracts
S007: EXTERNAL OBLIQUE INTERCOSTAL FASCIAL PLANE BLOCK FOR PATIENTS UNDERGOING OPEN HEPATECTOMIES: A CASE SERIES.
Tochukwu Ibe; Hari Kalagara; Kishan Patel; Mayo Clinic
Background: The external oblique intercostal (EOI) blocks have been demonstrated to cover the anterior and lateral upper abdominal walls that can be easily performed with identifiable landmarks and in the supine position (Elsharkaway et al 2021). At our institution we have seen some success of the EOI blocks in patients undergoing liver transplantation, of which postoperative pain control can be challenging since a neuraxial block is contraindicated with ongoing coagulopathy. This led us to translate our investigation to the utility of ultrasound-guided external oblique intercostal (EOI) blocks in patient underoing hepatectomies. Here, we present a small comparative case series.
Methods: This is a retrospective chart review comparing the postoperative opioid utilization of three liver resection patients with and without the EOI block. Local anesthetic is injected in the fascial plane between the external oblique and intercostal muscle at the T6 and T8 levels, unilaterally or bilaterally for somatic coverage of the right subcostal incision.
Results: The average oral morphine equivalents (OME) for POD 0, 1 and 2 were 10mg, 38mg, and 39mg in the EOI group and 11.7mg, 74mg, and 71mg in the control group (see table)
Discussion: 30ml of 0.25% bupivacaine mixed with 20ml of liposomal bupivacaine was used and 12.5ml of this mixture was injected at each level. The average OME for each postoperative day was higher in the control group compared to the EOI group. The average OME values in the control group were similar on POD 0 and close to doubled on POD 2 and 3 compared to EOI group. The EOI block made a clinically significant difference in our patients’ opioid usage and overall satisfaction. The EOI block is superficial with reliable sonoanatomy and can be performed in the supine position without interfering with the surgical incision. It’s simplicity, safety profile, and analgesic coverage is promising as an ideal block to be utilized in ERAS protocols for liver resection surgeries.
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Case Series |
Patient Group | POD 0 (OME) | POD 1 (OME) | POD 2 (OME) |
| Patient 1 | Block | 30 | 22 | 52 |
| Patient 2 | Block | 0 | 40 | 10 |
| Patient 3 | Block | 0 | 52 | 56 |
| Average consumption of OME in Patient 1-3 | 10 | 38 | 39 | |
| Patient 4 | Control | 15 | 80 | 123 |
| Patient 5 | Control | 10 | 72 | 25 |
| Patient 6 | Control | 10 | 70 | 65 |
| Average consumption of OME in Patient 4-6 | 11.7 | 74 | 71 |