The impact of external oblique intercostal block on early postoperative pain and recovery in patients undergoing J-shaped incisions for upper abdominal surgery: a single-center prospective randomized controlled study.

BACKGROUND

The aim of this study was to investigate the effects of external oblique intercostal nerve block (EOIB) on early postoperative pain and recovery in patients undergoing J-shaped incision surgery in the upper abdomen.

METHODS

Patients aged 18-85 years, classified as ASA I-III, undergoing elective open upper abdominal J-shaped incision surgery under general anesthesia were included in this study. Patients were randomized into two groups: the external oblique intercostal nerve block group (Group E ) and the control group (Group C ). Following induction of general anesthesia, Group E received 30 ml of 0.375% ropivacaine and 4 mg dexamethasone for ultrasound-guided EOIB on the surgical side, while Group C received no nerve block. Postoperatively, both groups utilized fentanyl patient-controlled intravenous analgesia. The primary outcome of the study was the 24-hour fentanyl consumption recorded for both groups. Patients with a Numeric Rating Scale (NRS) score > 4 were administered 40 mg parecoxib sodium as rescue analgesia.

RESULTS

Postoperative fentanyl consumption at 24 h was significantly lower in Group E compared to Group C (832.92 ± 66.42 μg vs. 1021.25 ± 76.63 μg, p = 0.001). Group E demonstrated lower NRS scores at rest and during movement at 0, 2, 4, 12, and 24 h postoperatively compared to Group C, but similar scores at 48 h. The time to first ambulation (49.92 ± 4.21 h vs. 58.38 ± 2.95 h, p = 0.001) and time to first flatus (59.79 ± 2.49 h vs. 67.83 ± 2.48 h, p = 0.001) were both shorter in Group E than in Group C, with higher Quality of Recovery-15 (QoR-15) scores in Group E (108.00 ± 3.80 vs. 97.00 ± 5.13, p = 0.001).

CONCLUSION

EOIB significantly enhances postoperative analgesia in patients undergoing upper abdominal J-shaped incision surgery, reducing opioid consumption and analgesic requirements, and improving the quality of recovery. It may be considered as part of a multimodal analgesic regimen following upper abdominal surgery.

TRIAL REGISTRATION: This study was registered in the Chinese Clinical Trial Testing Center (ID: ChiCTR2300076653, 10.13.2023).