Efficacy of ultrasound-guided external oblique intercostal plane block in laparoscopic common bile duct exploration: A double-blinded randomized controlled study.

BACKGROUND

Ultrasound-guided external oblique intercostal plane block (EOIPB) is a modified block technique used in the past few years for anterolateral upper abdominal wall analgesia. This study observed the efficacy of EOIPB in laparoscopic common bile duct exploration (LCBDE).

OBJECTIVES

To evaluate the efficacy of EOIPB in patients undergoing LCBDE.

METHODS

Sixty patients undergoing elective LCBDE were randomly assigned to two groups, an EOIPB group and a control group. In the EOIPB group, the patients received ultrasound-guided right EOIPB with a total of 20 mL of 0.5% ropivacaine before anesthesia induction. In the control group, the patients received no intervention before anesthesia induction. The primary outcomes were visual analog scale (VAS) scores within 24 h postoperatively and the number of patient-controlled analgesia (PCA) uses 24 h postoperatively. The secondary outcomes were dermatomal coverage of EOIPB, intraoperative vital signs, the intraoperative dose of remifentanil, and the 24-h postoperative quality of recovery-40 (QoR-40) score of the two groups.

RESULTS

In the EOI group, VAS scores at rest and movement were significantly lower than in the control group at 30 min, 6 h, and 12 h postoperation (p < 0.05), with no significant difference at 24 h (p > 0.05). The number of PCA uses within 24 h was significantly lower in the EOIPB group (1.60 ± 0.89) compared to the control group (2.50 ± 1.11, p < 0.05). Dermatomal coverage in the EOIPB group achieved 100% T6-T10 at the anterior median and midclavicular lines, 100% T6-T9 at the anterior axillary line, and 93.3% T7-T8 at the posterior axillary line. Mean arterial pressure (MAP) was significantly lower in the EOIPB group at skin incision (T2), 10 min postoperative (T3), and 30 min after extubation (T5) (p < 0.05), and heart rate (HR) was significantly lower at T2 (p < 0.05). The intraoperative remifentanil dose was significantly reduced in the EOIPB group (0.84 ± 0.13 mg) compared to the control group (0.94 ± 0.14 mg, p < 0.05). The EOIPB group had a shorter bedridden time (23.33 ± 2.81 h vs. 25.23 ± 3.64 h, p < 0.05) and a higher QoR-40 score (170.6 ± 5.2 vs. 165.5 ± 6.3, p < 0.05), indicating improved recovery.

CONCLUSION

The use of EOIPB in LCBDE can reduce VAS scores and the number of PCA uses 24 h postoperatively. EOIPB also steadied the intraoperative vital signs, reduced the dose of remifentanil, and improved the quality of recovery. EOIPB can be safely and effectively used in LCBDE.