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

Bakirkoy Dr. Sadi Konuk Research and Training Hospital104 enrolled

Overview

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.

Study Type

OBSERVATIONAL

Interventions

Bilateral External Oblique Intercostal Plane BlockPROCEDURE

Under ultrasound guidance, bilateral external oblique intercostal plane block was performed using a total of 40 mL of 0.25% bupivacaine solution, with 20 mL administered on each side. The final solution was prepared by mixing 20 mL of 0.5% bupivacaine with 20 mL of normal saline, corresponding to a total bupivacaine dose of 100 mg. The procedure was selected and performed by the attending anesthesiologist as part of routine clinical practice, independently of the study investigators.

Bilateral Rectus Sheath BlockPROCEDURE

Under ultrasound guidance, bilateral rectus sheath block was performed using a total of 20 mL of 0.25% bupivacaine solution, with 10 mL administered on each side. The final solution was prepared by mixing 10 mL of 0.5% bupivacaine with 10 mL of normal saline, corresponding to a total bupivacaine dose of 50 mg. The procedure was selected and performed by the attending anesthesiologist as part of routine clinical practice, independently of the study investigators.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

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

Outcomes

Primary Outcomes

Postoperative Pain Intensity Assessed by Visual Analog Scale

Postoperative pain intensity was assessed using a 0-10 visual analog scale, where 0 indicates no pain and 10 indicates the worst imaginable pain. Scores were compared between the two cohorts.

Time frame: At 1, 2, 4, 8, 12, and 24 hours after surgery

Secondary Outcomes

Total Intraoperative Remifentanil Consumption

The total cumulative dose of remifentanil administered during surgery was recorded in milligrams and compared between the two cohorts.

Time frame: From induction of anesthesia to the end of surgery

Total Postoperative Opioid Consumption

The total cumulative dose of intravenous tramadol administered as rescue analgesia was recorded in milligrams and compared between the two cohorts.

Time frame: During the first 24 hours after surgery

Patient Satisfaction With Postoperative Analgesia

Patient satisfaction with postoperative pain management was assessed using a 5-point Likert scale: 1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, and 5 = very satisfied. Scores were compared between the two cohorts.

Time frame: At 24 hours after surgery