Impact of external oblique intercostal plane block on postoperative pain and opioid consumption after laparoscopic sleeve gastrectomy: A systematic review and meta-analysis.

BACKGROUND AND AIMS: Laparoscopic sleeve gastrectomy (LSG) is effective for treating obesity but frequently causes significant postoperative pain. This meta-analysis evaluated the efficacy and safety of the external oblique intercostal plane block (EOIB) in reducing pain, opioid use, and adverse effects after LSG.

METHODS

This PROSPERO-registered review (CRD420251072075) searched seven major databases for comparative studies of EOIB versus placebo or other analgesic techniques in adults undergoing LSG. Primary outcomes were pain scores at rest and movement at 6, 12, and 24 h. Secondary outcomes included cumulative opioid consumption in Morphine Milligram Equivalents (MME) in the first 24 h, time to first rescue analgesia, complications or side effects like incidence of postoperative nausea and vomiting (PONV), and block related adverse events. Pooled effect sizes were calculated using a random effects model, with heterogeneity assessed via I².

RESULTS

Four randomised controlled trials (n = 265, 2024-2025) met inclusion criteria. EOIB significantly reduced pain at rest at 6 h [standardised mean difference (SMD) -0.69, I² = 0%], 12 h (SMD -0.56, I² = 59%), and 24 h (SMD -0.66, I² = 82%), with a pooled effect across all time points (SMD -0.62, I² = 63%). Pain at movement was significantly reduced overall (SMD -0.45, I² = 74%), with a notable effect at 12 h (SMD -0.59, I² = 76%). EOIB decreased 24 h opioid consumption by an average SMD of -1.65 (I² = 93%) and lowered the proportion of patients needing rescue analgesics by 41% [risk ratio (RR) 0.59, I² = 0%]. No significant differences were observed for time to first rescue analgesia (SMD 0.57, I² = 93%) or PONV (RR 0.85, I² = 37%). No block-related complications were reported.

CONCLUSION

This meta-analysis suggests that EOIB is a promising analgesic technique for patients undergoing LSG. It effectively reduces early postoperative pain and overall opioid consumption in the first 24 h. While no block-related complications were reported, larger, multicenter trials are necessary to confirm its efficacy, establish a definitive safety profile, and determine its role in multimodal pain management for bariatric surgery.