Shrey Shruti, Sinha Chandni, Kumar Abhyuday, Kumar Ajeet, Kumar Amarjeet, Nambiar Sreehari
Department of Anaesthesia, All India Institute of Medical Sciences, Patna, Bihar, India.
Indian J Anaesth. 2024 Nov;68(11):965-970. doi: 10.4103/ija.ija_596_24. Epub 2024 Oct 26.
Upper abdominal surgeries are associated with severe postoperative pain. External oblique intercostal (EOI) block blocks both anterior and lateral cutaneous branches of intercostal nerves. We compared the postoperative analgesic efficacy of unilateral EOI block with conventional unilateral subcostal transversus abdominis plane (TAP) block.
Fifty American Society of Anesthesiologists (ASA) I/II patients scheduled for upper abdominal surgery via subcostal incision were randomly assigned to receive either EOI block (Group E) or subcostal TAP block (Group T) with 25 mL of 0.2% ropivacaine. Postoperatively, these patients received intravenous (IV) fentanyl through a patient-controlled analgesia (PCA) pump with settings of demand-only mode. The primary outcome was the time to activation of PCA postoperatively. Secondary outcomes were 24-hour opioid consumption, pain scores (at 30 minutes and at 1, 2, 4, 6, 12, and 24 hours), patient satisfaction scores (48 hours), and block-related complications. Unpaired -test and Mann-Whitney U test were used for analysis. A value less than 0.05 was considered to be statistically significant.
Patients in Group E had an increased mean time of activation of PCA [610.28 [standard deviation (SD): 118.95)] minutes vs 409.68 (SD: 101.36) minutes] ( = 0.001). The 24-hour postoperative mean fentanyl consumption was 102.40 (SD: 25.70) μg in Group E versus 123.20 (SD: 34.38) μg in Group T ( = 0.019). Patients in Group E had better satisfaction scores ( < 0.001). Pain scores were better at 30 minutes and 6 hours.
EOI block provides effective postoperative analgesia in upper abdominal surgeries as it prolongs the duration of PCA activation with a better patient satisfaction score.
上腹部手术会引发严重的术后疼痛。腹外斜肌肋间肌（EOI）阻滞可同时阻断肋间神经的前皮支和外侧皮支。我们比较了单侧EOI阻滞与传统单侧肋下腹横肌平面（TAP）阻滞的术后镇痛效果。
50例计划通过肋下切口进行上腹部手术的美国麻醉医师协会（ASA）I/II级患者，随机分为两组，分别接受25毫升0.2%罗哌卡因的EOI阻滞（E组）或肋下TAP阻滞（T组）。术后，这些患者通过仅按需模式的患者自控镇痛（PCA）泵接受静脉注射（IV）芬太尼。主要结局指标是术后PCA启动时间。次要结局指标包括24小时阿片类药物消耗量、疼痛评分（术后30分钟以及1、2、4、6、12和24小时）、患者满意度评分（48小时）以及与阻滞相关的并发症。采用不成对t检验和曼-惠特尼U检验进行分析。P值小于0.05被认为具有统计学意义。
E组患者PCA启动的平均时间增加[610.28（标准差（SD）：118.95）分钟 vs 409.68（SD：101.36）分钟]（P = 0.001）。E组术后24小时芬太尼平均消耗量为102.40（SD：25.70）μg，T组为123.20（SD：34.38）μg（P = 0.019）。E组患者的满意度评分更高（P < 0.001）。在术后30分钟和6小时时疼痛评分更佳。
EOI阻滞在上腹部手术中提供了有效的术后镇痛，因为它延长了PCA启动的持续时间，患者满意度评分更高。
