External Oblique Intercostal Plane Block Versus Rectus Sheath Plane Block in Supra-umbilical Surgical Incisions; Randomized Controlled Double-Blinded Clinical Trial

Abstract

Article information Background: Surgical repair for supraumbilical hernias is a common surgical procedure that is often associated with significant post-operative pain. Some regional blocks have been described to alleviate pain after such procedures, including the "rectus sheath block"[RSB] and "external oblique intercostal plane block" [EOIPB]. Aim of the work: To compare the analgesic effects of RSB and EOIPB in patients undergoing procedures through upper midline laparotomies. Patients and Methods: This prospective randomized trial included 75 patients who were assigned into three groups: RSB group where the local anesthetic mixture [5 ml lidocaine 2%, 10 ml bupivacaine 0.25%, and 5 ml normal saline] was injected into the plane deep to the posterolateral muscle aspect, EOIPB group the same anesthetic mixture was delivered deep to the EOM and superficial to the ribs and intercostal musculature, and control group with no block Results: Preoperative parameters and operative time comparable in three groups of study. VAS during rest in both blocks were significantly lower compared to control group at all time points. The two block groups had comparable pain scores at the initial two readings. VAS during cough [or movement] showed similar findings. The patients requiring rescue opioid analgesia was lower in two block groups. The duration to the first rescue analgesia was in favor of the two block groups. The 24-hour morphine consumption had the lowest value in the EOIPB group, followed by the RSB group, the control group had the highest consumption. Conclusion: EOIPB is associated with better postoperative analgesia compared to the RSB. It is recommended that the former block be performed in such cases to enhance postoperative outcomes.