Ultrasound-Guided External Oblique Intercostal Plane Block Versus Subcostal Transversus Abdominis Plane Block For Perioperative Analgesia in Laparoscopic Sleeve Gastrectomy

Ultrasound-Guided External Oblique Intercostal Plane Block Versus Subcostal Transversus Abdominis Plane Block For Perioperative Analgesia in Laparoscopic Sleeve Gastrectomy

This study aims to compare the analgesic efficacy, duration of analgesia, and overall opioid consumption between the external oblique intercostal plane (EOIP) block and subcostal transversus abdominis plane (TAP) block in patients undergoing laparoscopic sleeve gastrectomy.

Postoperative pain management is a critical aspect of enhanced recovery after surgery (ERAS) protocols, particularly in laparoscopic bariatric procedures such as sleeve gastrectomy.

Among the ultrasound-guided abdominal wall blocks, the transversus abdominis plane (TAP) block and its subcostal variant have demonstrated efficacy for upper abdominal surgeries. The subcostal TAP block provides analgesia for the T6-T9 dermatomes, covering incisions in upper abdominal procedures like laparoscopic cholecystectomy and bariatric surgery.

The external oblique intercostal plane (EOIP) block is a relatively new fascial plane block that targets the intercostal nerves lying between the external oblique and intercostal muscles.

Inclusion Criteria:

• Age from 18 to 65 years.
• Both genders.
• American Society of Anesthesiologists (ASA) class I or II
• Body mass index (BMI) between 30-50 kg/m².
• Scheduled for elective laparoscopic sleeve gastrectomy under general anesthesia.
• Written informed consent from patients or surrogate decision makers.

Exclusion Criteria:

• Patient refusal.
• Allergy to local anesthetics.
• Coagulation disorders or anticoagulant therapy.
• Local infection or scar at the injection site.
• Severe hepatic or renal dysfunction.
• Chronic opioid use or psychiatric illness interfering with pain assessment.
• Conversion to open surgery or intraoperative complications requiring re-exploration.