Liotiri D, Diamantis A, Papapetrou E, Grapsidi V, Sioka E, Stamatiou G, Zacharoulis D
Anaesthetic Department IASO Thessalias General Hospital Larissa Greece.
Department of Surgery IASO Thessalias General Hospital Larissa Greece.
Anaesth Rep. 2023 Apr 27;11(1):e12225. doi: 10.1002/anr3.12225. eCollection 2023 Jan-Jun.
We report our clinical experience with the external oblique intercostal block in three consecutive adult patients who underwent liver surgery for resection of metastases. Enhanced recovery guidelines for liver surgery recommend intrathecal opioids and peripheral regional anaesthetic techniques in the context of multimodal analgesia to achieve adequate postoperative analgesia and early functional recovery. However, both laparoscopic and open approaches to liver surgery involve incisions in the upper abdomen, an anatomical area not well covered by previously described peripheral regional anaesthetic techniques. The external oblique intercostal block is a novel motor- and opioid-sparing technique which blocks both the anterior and lateral cutaneous branches of the thoracoabdominal nerves which innervate the upper abdominal quadrant. In all cases in this series, we performed the blocks in a short period of time and without complications. All patients remained pain- and opioid-free in the postoperative period and achieved enhanced recovery outcomes early. We found the external oblique intercostal block to be a simple, convenient, effective and opioid-sparing regional anaesthetic technique for postoperative analgesia after liver surgery. By minimising opioid use and by obviating the need for central neuraxial anaesthesia techniques in the postoperative period, this block could be incorporated into enhanced recovery protocols for hepatobiliary surgery.
我们报告了连续3例接受肝脏转移瘤切除术的成年患者行腹外斜肌肋间阻滞的临床经验。肝脏手术的加速康复指南建议在多模式镇痛中使用鞘内阿片类药物和外周区域麻醉技术，以实现充分的术后镇痛和早期功能恢复。然而，无论是腹腔镜还是开放手术方式，肝脏手术都涉及上腹部切口，这是一个先前描述的外周区域麻醉技术覆盖不佳的解剖区域。腹外斜肌肋间阻滞是一种新型的减少运动和阿片类药物使用的技术，它能阻滞支配上腹部象限的胸腹神经的前皮支和外侧皮支。在本系列的所有病例中，我们在短时间内完成了阻滞，且无并发症发生。所有患者术后均无疼痛且未使用阿片类药物，并早期实现了加速康复。我们发现腹外斜肌肋间阻滞是一种简单、方便、有效的减少阿片类药物使用的区域麻醉技术，用于肝脏手术后的术后镇痛。通过减少阿片类药物的使用，并避免术后使用中枢神经轴索麻醉技术，这种阻滞可纳入肝胆手术的加速康复方案。
