External Oblique Intercostal Plane Block With or Without Rectus Sheath Block After Laparoscopic Cholecystectomy

Comparison of Bilateral External Oblique Intercostal Plane Block With and Without Bilateral Rectus Sheath Block for Postoperative Analgesia After Laparoscopic Cholecystectomy: A Prospective Observational Cohort Study

This prospective observational cohort study compared postoperative pain outcomes in patients undergoing laparoscopic cholecystectomy who received bilateral external oblique intercostal plane block (EOIPB) alone or bilateral EOIPB combined with bilateral rectus sheath block (RSB). The block technique was selected by the attending anesthesiologist as part of routine clinical practice and was not assigned by the researchers.

Postoperative pain intensity was assessed using a 0-10 visual analog scale at 1, 2, 4, 8, 12, and 24 hours after surgery. Intraoperative remifentanil consumption, postoperative rescue analgesic consumption, hemodynamic measurements, postoperative nausea and vomiting, other analgesic-related adverse effects, and patient satisfaction were also evaluated during the first 24 postoperative hours.

Regional fascial plane blocks are used as part of multimodal analgesia after laparoscopic abdominal surgery. The external oblique intercostal plane block may provide analgesia to the upper anterior and lateral abdominal wall, while the addition of a rectus sheath block may improve analgesic coverage of the anterior abdominal wall.

This single-center prospective observational cohort study included 104 adult patients undergoing laparoscopic cholecystectomy. Patients were observed in two cohorts according to the regional anesthesia technique they received during routine clinical care: bilateral EOIPB alone or bilateral EOIPB combined with bilateral RSB. The attending anesthesiologist selected and performed the block technique independently of the study investigators. The investigators did not randomize participants or assign the regional anesthesia technique.

The primary objective was to compare postoperative pain intensity between the two cohorts using a 0-10 visual analog scale at 1, 2, 4, 8, 12, and 24 hours after surgery. Secondary assessments included intraoperative remifentanil consumption, postoperative rescue analgesic consumption during the first 24 hours, perioperative hemodynamic measurements, postoperative nausea and vomiting, other analgesic-related adverse effects, and patient satisfaction.

Routine perioperative anesthetic management and the standard postoperative analgesic regimen were similar in both cohorts. Additional rescue analgesics were administered according to individual clinical need, and the total rescue analgesic consumption during the first 24 postoperative hours was recorded. All study assessments were completed during the first 24 hours after surgery.

Inclusion Criteria:

• Adults aged 18 to 70 years
• American Society of Anesthesiologists physical status I to III
• Scheduled to undergo laparoscopic cholecystectomy
• Received bilateral EOIPB alone or bilateral EOIPB combined with bilateral RSB as part of routine clinical care
• Provided written informed consent to participate

Exclusion Criteria:

• Contraindication to regional block procedures, including coagulopathy, anticoagulant use, or local infection at the needle insertion site
• Known severe cardiovascular, renal, or hepatic disease
• Life-threatening hematological disease
• Neurological disease or psychiatric disorder
• Known allergy to the medications used in the study or to amide-type local anesthetics
• History of chronic pain
• History of narcotic substance or alcohol dependence
• Body mass index of 35 kg/m² or greater
• Pregnancy
• Refusal to participate