1
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Mehmet Selim Ç, Halide S, Erkan Cem Ç, Onur K, Sedat H, Senem U. Efficacy of Unilateral External Oblique Intercostal Fascial Plane Block Versus Subcostal TAP Block in Laparoscopic Cholecystectomy: Randomized, Prospective Study. Surg Innov 2024:15533506241256529. [PMID: 38780355 DOI: 10.1177/15533506241256529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND This study aimed to evaluate the effectiveness of unilateral external oblique intercostal nerve block (EOIB) in laparoscopic cholecystectomy surgery. MATERIAL AND METHODS After ethics committee approval, ASA I-II patients aged 18-70 who would undergo laparoscopic cholecystectomy surgery were included in the study. The patients were divided into two groups, external oblique intercostal nerve block (Group EOIB) and oblique subcostal transversus abdominis plane block (Group OSTAP). After surgery, EOIB or OSTAP block was administered with 20 mL of .25% bupivacaine then routine analgesia protocol was applied with iv paracetamol, and tramadol. Visual analog scale (VAS) scores and patient-controlled analgesia (PCA) consumption were monitored 24 hours after the operation. It was administered 25 mg pethidine as a rescue analgesic to patients with VAS ≥4. RESULTS Thirty six patients for Group EOIB and thirty four patients for Group OSTAP were included in the study. Lower VAS scores were observed in all groups. When PCA consumption, side effects, rescue analgesia consumption, and patient satisfaction were evaluated, there was no statistically significant difference between the groups (P > .05). CONCLUSION It was observed that EOIB showed similar analgesic activity to the OSTAP block. EOIB may also be a part of postoperative multimodal analgesia by reducing postoperative opioid consumption in LC.
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Affiliation(s)
- Çömez Mehmet Selim
- Department of Anesthesiology and Reanimation, Hatay Mustafa Kemal University, Tayfur Ata Sökmen Medical Faculty, Hatay, Türkiye
| | - Sağlambilen Halide
- Department of Anesthesiology and Reanimation, Hatay Mustafa Kemal University, Tayfur Ata Sökmen Medical Faculty, Hatay, Türkiye
| | - Çelik Erkan Cem
- Department of Anesthesiology and Reanimation, Atatürk University, Medical Faculty, Erzurum, Türkiye
| | - Koyuncu Onur
- Department of Anesthesiology and Reanimation, Hatay Mustafa Kemal University, Tayfur Ata Sökmen Medical Faculty, Hatay, Türkiye
| | - Hakimoğlu Sedat
- Department of Anesthesiology and Reanimation, Hatay Mustafa Kemal University, Tayfur Ata Sökmen Medical Faculty, Hatay, Türkiye
| | - Urfalı Senem
- Department of Anesthesiology and Reanimation, Hatay Mustafa Kemal University, Tayfur Ata Sökmen Medical Faculty, Hatay, Türkiye
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Kavakli AS, Sahin T, Koc U, Karaveli A. Ultrasound-Guided External Oblique Intercostal Plane Block for Postoperative Analgesia in Laparoscopic Sleeve Gastrectomy: A Prospective, Randomized, Controlled, Patient and Observer-Blinded Study. Obes Surg 2024; 34:1505-1512. [PMID: 38499943 PMCID: PMC11031435 DOI: 10.1007/s11695-024-07174-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Abstract
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.
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Affiliation(s)
- Ali Sait Kavakli
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Istinye University, 34396, Istanbul, Turkey.
- Istinye Universite Hastanesi, Aşık Veysel Mah, Süleyman Demirel Cd. No:1, 34517, Esenyurt, Istanbul, Turkey.
| | - Taylan Sahin
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Istinye University, 34396, Istanbul, Turkey
| | - Umit Koc
- Department of General Surgery, Faculty of Medicine, Istinye University, 34396, Istanbul, Turkey
| | - Arzu Karaveli
- Department of Anesthesiology and Reanimation, University of Health Sciences, Antalya Training and Research Hospital, 07100, Antalya, Turkey
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Mistry T, Sharma SK, Sonawane KB. External oblique intercostal plane block: Anatomical landmark-guided technique! Indian J Anaesth 2024; 68:504-505. [PMID: 38764951 PMCID: PMC11100660 DOI: 10.4103/ija.ija_172_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 05/21/2024] Open
Affiliation(s)
- Tuhin Mistry
- Department of Anaesthesiology and Perioperative Care, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, India
| | - Santosh K. Sharma
- Department of Anaesthesiology, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
| | - Kartik B. Sonawane
- Department of Anaesthesiology and Perioperative Care, Ganga Medical Centre and Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, India
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Doymus O, Ahiskalioglu A, Kaciroglu A, Bedir Z, Tayar S, Yeni M, Karadeniz E. External Oblique Intercostal Plane Block Versus Port-Site Infiltration for Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Study. Obes Surg 2024; 34:1826-1833. [PMID: 38565828 PMCID: PMC11031609 DOI: 10.1007/s11695-024-07219-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Although laparoscopic sleeve gastrectomy (LSG) is a minimally invasive surgery, postoperative pain is common. A novel block, the external oblique intercostal (EOI) block, can be used as part of multimodal analgesia for upper abdominal surgeries. The aim of our study is to investigate the effectiveness of EOI block in patients undergoing LSG. MATERIALS AND METHODS Sixty patients were assigned into two groups either EOI or port-site infiltration (PSI). The EOI group received ultrasound-guided 30 ml 0.25% bupivacaine, while the PSI group received 5 ml of 0.25% bupivacaine at each port sites by the surgeon. Data on clinical and demographic were collected and analyzed. RESULTS There were no statistical differences in terms of demographic details (p > 0.05). VAS scores were statistically lower during resting at PACU, 1, 2, 4, 8, and 12 h postoperatively in the EOI group than PSI group (p < 0.05), The VAS scores were also lower during active movement at PACU, 1, 2, 4, and 8 h postoperatively in the EOI group than PSI group (p < 0.05). Twenty-four-hour fentanyl consumption was lower in the EOI than in the PSI group (505.83 ± 178.56 vs. 880.83 ± 256.78 μg, respectively, p < 0.001). Rescue analgesia was higher in PSI group than EOI group (26/30 vs. 14/30, respectively, p = 0.001). CONCLUSION EOI block can be used as a part of multimodal analgesia due to its simplicity and effective postoperative analgesia in LSG.
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Affiliation(s)
- Omer Doymus
- Department of Anaesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Ali Ahiskalioglu
- Department of Anaesthesiology and Reanimation, Ataturk University School of Medicine, 25070, Erzurum, Turkey.
- Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, 25240, Erzurum, Turkey.
| | - Ahmet Kaciroglu
- Department of Anaesthesiology and Reanimation, Bursa City Hospital, Bursa, Turkey
| | - Zehra Bedir
- Department of Anaesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Serkan Tayar
- Department of General Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Mustafa Yeni
- Department of General Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Erdem Karadeniz
- Department of General Surgery, Ataturk University School of Medicine, Erzurum, Turkey
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5
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Bansal P, Sultania N, Arora D. External oblique intercostal plain block - A single injection solution to anterolateral upper abdominal wall analgesia. Saudi J Anaesth 2024; 18:309-310. [PMID: 38654863 PMCID: PMC11033911 DOI: 10.4103/sja.sja_730_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 04/26/2024] Open
Affiliation(s)
| | - Nidhi Sultania
- Department of Anaesthesia, PGIMS, Rohtak, Haryana, India
| | - Divesh Arora
- Anaesthesia and OT Services, Asian Hospital Faridabad, Haryana, India
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Ökmen K. Ultrasound-guided external oblique and rectus abdominis plane "EXORA" block for postoperative pain after laparoscopic cholecystectomy: a propensity-matched study. Minerva Anestesiol 2023; 89:1074-1081. [PMID: 37851417 DOI: 10.23736/s0375-9393.23.17524-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Various types of plane blocks are used for analgesia in the upper abdomen. The purpose of this study was to evaluate the efficacy of the external oblique and rectus abdominis plane (EXORA) block for antero-lateral upper abdominal analgesia. METHODS This study included 60 patients undergoing laparoscopic cholecystectomy. Patients were divided into control group, intravenous patient-controlled analgesia (IV.PCA) (N.=30) and EXORA group (block with 25 mL 0.25% bupivacaine + IV.PCA [N.=30]). Postoperative pain (at rest) was evaluated at 30 minutes, two, four, six, 12 and 24 hours using Visual Analogue Scale (VAS) scores. Postoperative activity pain at two, four, six, 12 and 24 hours was also assessed using VAS. Secondary outcomes included tramadol use at 12 and 24 hours after surgery, side effect profile, dermatomal spread, and additional analgesic use. RESULTS The VAS scores were statistically significantly lower in the EXORA group compared to the other groups (P<0.001). In addition, mean tramadol consumption at 12 and 24 hours was statistically significantly lower in the EXORA group (P<0.001). Sensory block was recorded in the lateral and anterior abdomen at T6 to T11 after EXORA block application. CONCLUSIONS The EXORA block used to provide analgesia after laparoscopic cholecystectomy provides analgesia to the upper abdominal wall. Further data may be obtained from cadaveric studies and other studies.
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Affiliation(s)
- Korgün Ökmen
- Department of Anesthesiology and Reanimation, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Türkiye - korgunokmen @gmail.com
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7
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Wilkinson-Maitland N, Cunningham AJ, Esfahanian M. Postoperative analgesia for Kasai portoenterostomy using external oblique intercostal blocks. Reg Anesth Pain Med 2023; 48:619-621. [PMID: 37474282 DOI: 10.1136/rapm-2023-104510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/02/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND External Oblique Intercostal (EOI) fascial plane blockade is a relatively new regional anesthetic technique used for a variety of upper abdominal surgical procedures. Proponents of this block praise its simple sonoanatomy, extensive local anesthetic (LA) spread, and ease of catheter placement, while avoiding encroachment into the surgical field or dressing sites; nevertheless, it is underutilized in pediatric surgery. Kasai portoenterostomy is a common pediatric surgical procedure for biliary atresia typically done via an open abdominal approach with an extended subcostal incision. Postoperative analgesic management with epidural anesthetic techniques are considered but may be limited by periprocedural coagulopathy concerns. CASE PRESENTATION We present a case of a neonate who underwent successful analgesic management of Kasai portoenterostomy with bilateral EOI block catheters. Opioid consumption and other postoperative outcomes were comparative to previously reported literature of epidural analgesia in this patient population. CONCLUSIONS The purpose of this report is to describe the outcomes and technical approach in a neonate who received EOI blocks as an alternative to epidural anesthetic management. Further studies are needed to compare the efficacy and complication rate of EOI blockade to epidural analgesia for Kasai portoenterostomy surgery.
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Affiliation(s)
- Nigel Wilkinson-Maitland
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Aaron J Cunningham
- Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Mohammad Esfahanian
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, Palo Alto, California, USA
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Ohgoshi Y, Kawagoe I. In reply: Comments on blockade of thoracoabdominal nerves through the perichondrial approach. Can J Anaesth 2023:10.1007/s12630-023-02632-x. [PMID: 37907814 DOI: 10.1007/s12630-023-02632-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 11/02/2023] Open
Affiliation(s)
- Yuichi Ohgoshi
- Department of Anaesthesiology, Keiyu Hospital, Kanagawa, Japan.
- Department of Anaesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan.
| | - Izumi Kawagoe
- Department of Anaesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
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9
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Tulgar S. Comments on blockade of thoracoabdominal nerves through the perichondrial approach. Can J Anaesth 2023:10.1007/s12630-023-02631-y. [PMID: 37907813 DOI: 10.1007/s12630-023-02631-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 11/02/2023] Open
Affiliation(s)
- Serkan Tulgar
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University, Samsun, Turkey.
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10
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Tulgar S, Ciftci B, Ahiskalioglu A, Bilal B, Alver S, Sakul BU, Ansen G, Pence KB, Alici HA. Recto-intercostal fascial plane block: Another novel fascial plane block. J Clin Anesth 2023; 89:111163. [PMID: 37295124 DOI: 10.1016/j.jclinane.2023.111163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/02/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Serkan Tulgar
- Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Department of Anesthesiology and Reanimation, Samsun, Turkey
| | - Bahadir Ciftci
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
| | - Ali Ahiskalioglu
- Ataturk University School of Medicine, Department of Anesthesiology and Reanimation, Development and Design Application and Research Center, Erzurum, Turkey
| | - Bora Bilal
- Kahramanmaras Sutcu Imam University Faculty of Medicine, Department of Anesthesiology and Reanimation, Kahramanmaras, Turkey
| | - Selcuk Alver
- Istanbul Medipol University, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - Bayram Ufuk Sakul
- Istanbul Medipol University, Department of Anatomy, Istanbul, Turkey
| | - Gamze Ansen
- Istanbul Medipol University, Department of Anatomy, Istanbul, Turkey
| | | | - Hacı Ahmet Alici
- Istanbul Medipol University, Department of Algology, Istanbul, Turkey
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11
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Chan WK, Tan KW, Chong KP, Lim ACC, Khalid I. Bilateral External Oblique Intercostal Catheter for Post-operative Analgesia After Open Pancreaticoduodenectomy: A Case Report. Cureus 2023; 15:e47189. [PMID: 38021569 PMCID: PMC10652169 DOI: 10.7759/cureus.47189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Open pancreaticoduodenectomy, also known as Whipple surgery, is a complex and painful procedure that requires a multi-modal analgesic approach for successful post-operative rehabilitation and recovery. While thoracic epidural analgesia (TEA) remains the gold standard for pain relief after open upper abdominal surgery, it carries many risks that may outweigh the potential benefits of the technique. Furthermore, in laparoscopic converted to open pancreaticoduodenectomy cases, post-operative placement of a thoracic epidural catheter is inconvenient to the patient due to pain and positioning. The external oblique intercostal (EOI) block is a novel method that provides somatic analgesia to the upper abdomen. We present a case of bilateral EOI block with catheter insertion for post-operative analgesia in a patient who underwent laparoscopic converted to open Whipple surgery.
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Affiliation(s)
- Weng Ken Chan
- Anaesthesiology and Intensive Care, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Kok Wang Tan
- Anaesthesiology and Intensive Care, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Kok Peng Chong
- Anaesthesiology and Intensive Care, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Angelina Chia Chia Lim
- Anaesthesiology and Intensive Care, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Iskandar Khalid
- Anaesthesiology and Intensive Care, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
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12
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Ohgoshi Y, Mizuguchi-Tate A, Kawagoe I. External oblique muscle plane blocks in combination with modified thoracoabdominal nerves block through perichondrial approach for analgesia in abdominal surgery: A case report. Saudi J Anaesth 2023; 17:413-415. [PMID: 37601492 PMCID: PMC10435807 DOI: 10.4103/sja.sja_807_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/19/2022] [Indexed: 08/22/2023] Open
Abstract
The costal and lateral external oblique muscle plane (EXOP) blocks anesthetize the lateral cutaneous branches, whereas the modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) anesthetizes the anterior branches of the thoracoabdominal nerves. Herein, we report two cases of successful perioperative pain management with the combination of these blocks: case 1 was a 67-year-old man who underwent open cholecystectomy and case 2 was a 38-year-old woman who underwent emergency laparoscopic surgery for strangulation ileus. Both patients were administered the costal and/or lateral EXOP blocks along with bilateral M-TAPA for perioperative analgesia. A pin-prick test performed 1 h after surgery revealed that the cutaneous sensory block covered all areas of the abdominal surgical field. Combined use of these blocks can be a new local analgesic strategy for abdominal surgery.
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Affiliation(s)
- Yuichi Ohgoshi
- Department of Anesthesiology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, Japan
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Aki Mizuguchi-Tate
- Department of Anesthesiology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, Japan
| | - Izumi Kawagoe
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, Japan
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Aniskevich S, Scott CL, Ladlie BL. The Practice of Fast-Track Liver Transplant Anesthesia. J Clin Med 2023; 12:jcm12103531. [PMID: 37240637 DOI: 10.3390/jcm12103531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Prior to the 1990s, prolonged postoperative intubation and admission to the intensive care unit was considered the standard of care following liver transplantation. Advocates of this practice speculated that this time allowed patients to recover from the stress of major surgery and allowed their clinicians to optimize the recipients' hemodynamics. As evidence in the cardiac surgical literature on the feasibility of early extubation grew, clinicians began applying these principles to liver transplant recipients. Further, some centers also began challenging the dogma that patients need to be cared for in the intensive care unit following liver transplantation and instead transferred patients to the floor or stepdown units immediately following surgery, a technique known as "fast-track" liver transplantation. This article aims to provide a history of early extubation for liver transplant recipients and offer practical advice on how to select patients that may be able to bypass the intensive care unit and be recovered in a non-traditional manner.
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Affiliation(s)
- Stephen Aniskevich
- Department of Anesthesiology, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Courtney L Scott
- Department of Anesthesiology, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Beth L Ladlie
- Department of Anesthesiology, Mayo Clinic Florida, Jacksonville, FL 32224, USA
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14
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Petiz C, Barbosa R, Ribeiro Boneco T, Pacheco J, Resende A. External Oblique Intercostal Block for Living Kidney Donor Open Nephrectomy: A Case Series. Cureus 2023; 15:e39139. [PMID: 37332413 PMCID: PMC10275393 DOI: 10.7759/cureus.39139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
The external oblique intercostal (EOI) block is a novel regional technique that provides analgesia for upper abdominal incisions. We performed single-injection and continuous EOI blocks in living kidney donors who underwent open nephrectomy. In this case series, we report our experience with pain management using this technique in five patients at our centre. EOI block resulted in good pain relief in our patients. The median (IQR) numerical rating scale score was 3 (1-6) at rest immediately after the end of the surgery, predominantly visceral. We want to highlight the benefits regarding pain management of the association of EOI block with conventional therapy.
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Affiliation(s)
- Catarina Petiz
- Anesthesiology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | - Rita Barbosa
- Anesthesiology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | | | - Jânia Pacheco
- Anesthesiology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | - Alexandra Resende
- Anesthesiology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
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Liotiri D, Diamantis A, Papapetrou E, Grapsidi V, Sioka E, Stamatiou G, Zacharoulis D. External oblique intercostal (EOI) block for enhanced recovery after liver surgery: a case series. Anaesth Rep 2023; 11:e12225. [PMID: 37124666 PMCID: PMC10139870 DOI: 10.1002/anr3.12225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 05/02/2023] Open
Abstract
We report our clinical experience with the external oblique intercostal block in three consecutive adult patients who underwent liver surgery for resection of metastases. Enhanced recovery guidelines for liver surgery recommend intrathecal opioids and peripheral regional anaesthetic techniques in the context of multimodal analgesia to achieve adequate postoperative analgesia and early functional recovery. However, both laparoscopic and open approaches to liver surgery involve incisions in the upper abdomen, an anatomical area not well covered by previously described peripheral regional anaesthetic techniques. The external oblique intercostal block is a novel motor- and opioid-sparing technique which blocks both the anterior and lateral cutaneous branches of the thoracoabdominal nerves which innervate the upper abdominal quadrant. In all cases in this series, we performed the blocks in a short period of time and without complications. All patients remained pain- and opioid-free in the postoperative period and achieved enhanced recovery outcomes early. We found the external oblique intercostal block to be a simple, convenient, effective and opioid-sparing regional anaesthetic technique for postoperative analgesia after liver surgery. By minimising opioid use and by obviating the need for central neuraxial anaesthesia techniques in the postoperative period, this block could be incorporated into enhanced recovery protocols for hepatobiliary surgery.
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Affiliation(s)
- D. Liotiri
- Anaesthetic DepartmentIASO Thessalias General HospitalLarissaGreece
| | - A. Diamantis
- Department of SurgeryIASO Thessalias General HospitalLarissaGreece
| | - E. Papapetrou
- Accident & Emergency DepartmentLewisham and Greenwich NHS TrustLondonUK
| | - V. Grapsidi
- Department of SurgeryGeneral Hospital of TrikalaTrikalaGreece
| | - E. Sioka
- Department of SurgeryIASO Thessalias General HospitalLarissaGreece
| | - G. Stamatiou
- Anaesthetic DepartmentIASO Thessalias General HospitalLarissaGreece
| | - D. Zacharoulis
- Department of SurgeryUniversity of ThessalyLarissaGreece
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Fascial plane blocks: moving from the expansionist to the reductionist era. Can J Anaesth 2022; 69:1185-1190. [PMID: 35999333 DOI: 10.1007/s12630-022-02309-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/17/2022] [Accepted: 07/13/2022] [Indexed: 01/12/2023] Open
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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 Anaesth 2022; 69:1203-1210. [PMID: 35999334 DOI: 10.1007/s12630-022-02310-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE No reports have described techniques to efficiently anesthetize the lateral cutaneous branches of the entire abdomen. The aim of this study was to investigate an effective procedure for blocking the lateral cutaneous branches in the abdominal region. We sought to describe the sensory distribution of the previously described thoracoabdominal nerve block through perichondrial approach (TAPA) and the novel costal and lateral external oblique muscle plane (EXOP) blocks in healthy volunteers. METHODS This was a proof-of-concept pilot study that comprised ten volunteers with an American Society of Anesthesiologists Physical Status I. The participants underwent modified TAPA (M-TAPA), injection 2 of TAPA (injection into the anterior aspect of the 10th costal cartilage: I2-TAPA), costal EXOP, and lateral EXOP blocks with injection of 20 mL of ropivacaine 0.2% for each block. A pinprick test was performed one hour after injection and repeated at 30-min intervals until the effect of the nerve block disappeared. RESULTS The M-TAPA injection anesthetized the anterior branches from T6/7 to T11/12, whereas the I2-TAPA injection had no effect. Costal and lateral EXOP injections anesthetized the lateral cutaneous branches of T7-10 and T11-12, respectively. CONCLUSION The results of this pilot study in ten healthy volunteers indicate that novel EXOP blocks involving local anesthetic injection superficial to the external oblique muscle efficiently anesthetize the lateral cutaneous branches of the thoracoabdominal nerves. Our study shows that it may be anatomically plausible for the combined use of these blocks to anesthetize the entire abdominal wall.
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Affiliation(s)
- Yuichi Ohgoshi
- Department of Anaesthesiology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-8521, Japan. .,Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan.
| | - Izumi Kawagoe
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Aki Ando
- Department of Anaesthesiology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-8521, Japan
| | - Maria Ikegami
- Department of Anaesthesiology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-8521, Japan
| | - Sayako Hanai
- Department of Anaesthesiology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa, 220-8521, Japan
| | - Koichiro Ichimura
- Department of Anatomy and Life Structure, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Coşarcan SK, Erçelen Ö. The analgesic contribution of external oblique intercostal block: Case reports of 3 different surgeries and 3 spectacular effects. Medicine (Baltimore) 2022; 101:e30435. [PMID: 36086688 PMCID: PMC10980467 DOI: 10.1097/md.0000000000030435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/28/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Abdominal wall blocks are frequently used due to the use of effective blocks, such as the transversus abdominis plane (TAP) block and the widespread use of ultrasound (US) imaging. A good knowledge of abdominal innervation is required for the use of abdominal wall blocks. We describe the extraordinary performance of external oblique intercostal (EOI) blocks in 3 different surgeries. PATIENT CONCERNS, DIAGNOSIS AND INTERVENTIONS Case 1: A man aged 30 to 35 was taken to the operating room for open liver surgery. After surgery, unilateral EOI block and bilateral TAP block were performed with the patient in the supine position, and a catheter was placed under the external oblique muscle. Postoperative analgesia was followed by patient-controlled analgesia (PCA) through the catheter. Case 2: A male patient aged 35 to 40 was taken to the operating room for laparoscopic liver surgery. After surgery, unilateral (EOI) block and bilateral TAP block were performed with the patient in the supine position. The patient received iv tramadol PCA (bolus dose 10 mg only, lockout 20 minutes). Case 3: A man aged 25 to 30 was taken to the operating room for laparoscopic bariatric surgery. After the surgery, bilateral EOI and bilateral rectal sheath blocks were performed with the patient in the supine position. The patient received iv tramadol PCA (bolus dose 10 mg only, lockout 20 minutes). OUTCOMES All patients had low NRS scores in the recovery unit and very low opioid consumption in the first 72 hours postoperatively. All were satisfied with the quality of analgesia. CONCLUSION We think that EOI block will come to occupy a significant place in upper abdominal analgesia, especially in obese patients, due to its wide innervation area and ease of application.
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Affiliation(s)
| | - Ömür Erçelen
- VKV American Hospital, Anesthesiology and Pain, Istanbul, Turkey
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Can Postoperative Pain Be Prevented in Bariatric Surgery? Efficacy and Usability of Fascial Plane Blocks: a Retrospective Clinical Study. Obes Surg 2022; 32:2921-2929. [PMID: 35776242 DOI: 10.1007/s11695-022-06184-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
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 medications such as ketamine or gabapentin have been suggested for reduction of the opioid usage. Regional anesthetic techniques represent a valuable option as they improve patient comfort while reducing opioid-related side effects. In this study, we have evaluated the adjuvant benefits of these various techniques in reduction of the postoperative pain in bariatric surgery. METHODS After the approval of the IRB Ethics Committee, the records of the patients who had laparoscopic bariatric surgery between January 2019 and December 2021 were reviewed retrospectively. RESULTS Records of 120 patients who underwent laparoscopic bariatric surgery between January 2019 and December 2021 were reviewed. In total, 113 patients with full documentation were included in this study. Among these, 74 patients were administered regional analgesia. The main regional analgesia techniques were transversus abdominis plane and rectus sheath block. The pain scores of those receiving regional analgesia were statistically low. The opioid consumption after transversus abdominis plane and rectus sheath block was significantly lower than that of others. External oblique intercostal block alone provides a postoperative opioid consumption similar to those of transversus abdominis plane and rectus sheath block. CONCLUSION The use of fascial plane blocks in bariatric surgery significantly reduces opioid consumption. Transversus abdominis plane and rectus sheath block combination and external oblique intercostal block seem to be the most effective options. CLINICAL TRIALS NUMBER NCT05284695.
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White L, Ji A. External oblique intercostal plane block for upper abdominal surgery: use in obese patients. Br J Anaesth 2022; 128:e295-e297. [DOI: 10.1016/j.bja.2022.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/13/2022] [Accepted: 02/13/2022] [Indexed: 11/02/2022] Open
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