Bilateral External Oblique Intercostal Plane Bock (EOIPB) in Upper Abdominal Surgeries

Analgesic Efficacy of Ultrasound Guided Bilateral External Oblique Intercostal Plane Block Versus Rectus Sheath Block in Upper Abdominal Surgeries: A Randomized Double-blinded Controlled Study

The current study is designed to investigate the analgesic potentials of two modalities of abdominal blocks where local anesthetics is injected in the fascial planes of the abdominal muscles to anesthetize the nerves supplying the abdomen in patients undergoing upper abdomial surgeries.

the two modalities are the rectus sheath block (RSB) and the external oblique intercostal plane block (EOIPB). The investigators are going to use the ultrasound to identify the muscles and inject the local anesthetics. The investigators suggest that the EOIPB might provide better pain control when compared to RSB.

Fascial plane blocks emerge as an appealing technique to provide good intraoperative and postoperative analgesia in patients undergoing upper abdominal surgeries. Such techniques have the benefit of decreasing opioids use and consequently reducing the like hood of their side effects.

Ultrasound guided rectus sheath Block (RSB) targets the terminal branches of thoracic nerves thus providing analgesia for midline abdominal incisions.

Ultrasound guided external oblique intercostal plane block (EOIPB), a relatively new technique, targets the lateral cutaneous branches of the thoracoabdominal nerves providing analgesia for anterolateral and upper median plane of the abdomen.

Studies Comparing both techniques are deficient, that is why the investigators designed the current study to evaluate and compare the analgesic efficacy of both techniques in upper abdominal surgeries namely Whipple operation and total gastrectomy.

The study is a randomized controlled double blinded trial comprising two groups. The RSB group will receive bilateral ultrasound guided rectus sheath block with 20ml of 0.25% bupivacaine on each side. The EOIB group will receive bilateral ultrasound guided External oblique intercostal plane block with 20ml of 0.25% bupivacaine on each side as well. Both blocks will be performed after administering general anesthesia.

The main endpoint of the study is the time to first request for rescue analgesia.

Inclusion Criteria:

• Age from 18 to 65 Years
• Both sexes.
• American Society of Anesthesiologists (ASA) physical status II, III.
• Patients who will undergo upper abdominal surgeries (Whipple operation, total gastrectomy).

Exclusion Criteria:

• Coagulation disorders.
• Abdominal surgery history.
• Infection in the block application area.
• Chronic opioid use.
• Local anesthetic (LA) allergy.
• Pregnancy.
• BMI ≥35 kg/m2.
• Severe cardiovascular problems.
• Diabetic neuropathy.
• Complicated surgeries with massive blood loss and hemodynamic instability.