External oblique vs. subcostal TAP block in upper abdominal surgery: RCT

Interfascial plane blocks have been successfully used for upper abdominal surgeries with subcostal incision. External oblique intercostal (EOI) plane block is a novel technique for providing upper abdominal analgesia. In this study we have compared the analgesic efficacy of ultrasound (US) guided EOI Block and subcostal Transversus Abdominis Plane (STAP) block in adult patients undergoing surgery with unilateral subcostal incisions.

Fifty, ASA I-II patients(18-65 years) undergoing upper abdominal surgery were randomised into two groups: Group E received US-guided EOI Plane block and Group T received US-guided STAP block.(Fig 1) Both groups received the block with 25ml of 0.2% Ropivacaine after general anaesthesia. Primary outcome was time to first rescue analgesia. Secondary outcomes were intraoperative fentanyl consumption, 24 hour postoperative fentanyl consumption, postoperative pain scores at 0,1,2,4, 6, 12 and 24 hrs and adverse effects.

Demographic and surgical characteristics were comparable in both the groups. Mean time for first rescue analgesia in Group E was 610±118.90 minutes and Group T was 409.68±101.36 minutes(P=0.001). Intraoperative fentanyl consumption did not show any significant difference while 24 – hour postoperative fentanyl consumption was more in in Group T ( 123.20±34.48mcg vs 102.40±25.70 mcg) in group E. (P=0.019). Pain scores remained lower in Group E as compared to Group T throughout 24 hours with statistically significant difference at 1 and 6 hour.

Ultrasound guided EOI Plane Block is a better analgesic technique than Subcostal TAP Block in patients undergoing upper abdominal surgeries with less opioid consumption and pain scores.