Efficacy of Ultrasound-Guided External Oblique Intercostal Plane Block in Laparoscopic Gastrectomy: A Randomized Controlled Study

JIA Qianqian; YANG Yating; WU Chenxi; SUN Qian; WANG Qiujun; LIU Fei; LIU Zhuo

PDF(2400 KB)

Journal of Hunan Normal University(Medical Science) ›› 2026, Vol. 23 ›› Issue (3) : 27-32.

Efficacy of Ultrasound-Guided External Oblique Intercostal Plane Block in Laparoscopic Gastrectomy: A Randomized Controlled Study

JIA Qianqian¹, YANG Yating¹, WU Chenxi¹, SUN Qian¹, WANG Qiujun², LIU Fei¹, LIU Zhuo¹

Author information +

History +

Abstract

Objective To observe the efficacy of ultrasound-guided external oblique intercostal plane block (EOIPB) in patients undergoing laparoscopic gastrectomy. Methods 80 patients undergoing elective laparoscopic gastrectomy were randomly divided into two groups, an EOIPB group and a control group. In the EOIPB group, the patients received ultrasound-guided bilateral EOIPB 20 mL of 0.5% ropivacaine administered on each side 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 EOIPB group, the intraoperative remifentanil dose was significantly reduced (1.74±0.25 mg) compared to the C group (1.93±0.13mg, P<0.05). The number of PCA uses within 24 h was significantly lower in the EOIPB group (1.55±1.00) compared to C group (5.18±1.33, P<0.05). Dermatomal coverage in the EOIPB group achieved 100% T6-T10 at the anterior median and midclavicular line, 87.5% T6-T10 at the anterior axillary line, and 95% T7-T8 at the posterior axillary line. VAS scores at rest and movement were significantly lower in the EOIPB group than in the control group at 30min, 6h, and 12h postoperation (P<0.05), with no significant difference at 24 h (P>0.05). 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 EOIPB group had a shorter bedridden time (24.50±2.46 h vs 27.33±2.95 h, P<0.05) and a higher QoR-40 score (170.15±4.89 vs.165.40±6.41, P<0.05), indicating improved recovery. The incidence of adverse reactions in the EOIPB group (15.0%) was significantly reduced compared to the C group (37.5%, P<0.05). Conclusion EOIPB in laparoscopic gastrectomy can reduce the use of analgesic drugs during and after surgery. EOIPB also steadied the intraoperative vital signs, reduced pain sensations, and improved the quality of recovery. EOIPB can be safely and effectively used in laparoscopic gastrectomy.

Key words

ultrasound-guided / external oblique intercostal plane block / nerve block / laparoscopic gastrectomy / postoperative recovery quality

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

JIA Qianqian, YANG Yating, WU Chenxi, SUN Qian, WANG Qiujun, LIU Fei, LIU Zhuo. Efficacy of Ultrasound-Guided External Oblique Intercostal Plane Block in Laparoscopic Gastrectomy: A Randomized Controlled Study[J]. Journal of Hunan Normal University(Medical Science). 2026, 23(3): 27-32

References

[1] LI J, LI S, XI H, et al.Effect of preoperative nutrition therapy type and duration on short-time outcomes in gastric cancer patient with gastric outlet obstruction[J]. Chin J Cancer Res, 2021, 33(2): 232-242.
[2] JAPANESE GASTRIC CANCER ASSOCIATION. Japanese gastric cancer treatment guidelines 2018(5th edition)[J]. Gastric Cancer, 2021, 24(1): 1-21.
[3] ZHU M, QI Y, HE H, et al.Effect of quadratus lumborum block on postoperative cognitive function in elderly patients undergoing laparoscopic radical gastrectomy: a randomized controlled trial[J]. BMC Geriatr, 2021, 21(1): 238.
[4] CHEN S, CHEN C, HU Y, et al.Three-dimensional ex vivo culture for drug responses of patient-derived gastric cancer tissue[J]. Front Oncol, 2020, 10: 614096.
[5] DESAI N, EL-BOGHDADLY K, ALBRECHT E.Epidural vs transversus abdominis plane block for abdominal surgery: a systematic review, meta-analysis and trial sequential analysis[J]. Anaesthesia, 2021, 76(1): 101-117.
[6] SALICATH JH, YEOH EC, BENNETT MH. Epidural analgesia versus patient-controlled intravenous analgesia for pain following intra-abdominal surgery in adults[J]. Cochrane Database Syst Rev, 2018, 8(8): CD010434.
[7] ELSHARKAWY H, KOLLI S, SOLIMAN LM, et al.The external oblique intercostal block: anatomic evaluation and case series[J]. Pain Med, 2021, 22(11): 2436-2442.
[8] LIOTIRI D, DIAMANTIS A, PAPAPETROU E, et al.External oblique intercostal (EOI) block for enhanced recovery after liver surgery: a case series[J]. Anaesth Rep, 2023, 11(1): e12225.
[9] WHITE L, JI A.External oblique intercostal plane block for upper abdominal surgery: use in obese patients[J]. Br J Anaesth, 2022, 128(5): e295-e297.
[10] WILKINSON-MAITLAND N, CUNNINGHAM AJ, ESFAHANIAN M.Postoperative analgesia for Kasai portoenterostomy using external oblique intercostal blocks[J]. Reg Anesth Pain Med, 2023, 48(6): 619-621.
[11] SVEINSDOTTIR H, BORGTHORSDOTTIR T, ASGEIRSDOTTIR MT, et al.Recovery after same-day surgery in patients receiving general anesthesia: a cohort study using the quality of Recovery-40 Questionnaire[J]. J Perianesth Nurs, 2016, 31(6): 475-484.
[12] JIAO J, LIU S, CHEN C, et al.Comparative study of laparoscopic radical gastrectomy and open radical gastrectomy[J]. J Minim Access Surg, 2020, 16(1): 41-46.
[13] BALOCCO AL, LÓPEZ AM, KESTELOOT C, et al. Quadratus lumborum block: an imaging study of three approaches[J]. Reg Anesth Pain Med, 2021, 46(1): 35-40.
[14] LI TT, CHANG QY, XIONG LL, et al.Patients with gastroenteric tumor after upper abdominal surgery were more likely to require rescue analgesia than lower abdominal surgery[J]. BMC Anesthesiol, 2022, 22(1): 156.
[15] HUI V, HYMAN N, VISCOMI C, et al.Implementing a fast-track protocol for patients undergoing bowel resection: not so fast[J]. Am J Surg, 2013, 206(2): 152-158.
[16] MACRAE WA.Chronic post-surgical pain: 10 years on[J]. Br J Anaesth, 2008, 101: 77-86.
[17] ELSHARKAWY H, PAWA A, MARIANO ER.Interfascial Plane Blocks: Back to Basics[J]. Regional anesthesia and pain medicine, 2018, 43(4): 341-346.
[18] CHIN KJ, LIRK P, HOLLMANN MW, et al.Mechanisms of action of fascial plane blocks: a narrative review[J]. Reg Anesth Pain Med, 2021, 46(7): 618-628.
[19] HASKINS SC, MEMTSOUDIS SG.Fascial plane blocks for cardiac surgery: new frontiers in Analgesia and nomenclature. Anesth Analg, 2020, 131: 125-126.
[20] EL-BOGHDADLY K, WOLMARANS M, STENGEL AD, et al.Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of abdominal wall, paraspinal, and chest wall blocks[J]. Reg Anesth Pain Med, 2021, 46(7): 571-580.
[21] OZCIFTCI S, SAHINER Y, SAHINER IT, et al.Is right unilateral transversus abdominis plane (TAP) block successful in postoperative analgesia in laparoscopic cholecystectomy?[J] Int J Clin Pract, 2022, 2022: 2668215.
[22] HAMILTON DL, MANICKAM BP.Is a thoracic fascial plane block the answer to upper abdominal wall analgesia?[J] Reg Anesth Pain Med, 2018, 43(8): 891-892.
[23] HAMILTON DL, MANICKAM BP, WILSON MAJ, et al.External oblique fascial plane block[J]. Reg Anesth Pain Med, 2019, 44(4): 528-529.
[24] THAKORE S, MISTRY T, NAIR AS, et al.External oblique intercostal plane block: a scoping review of anatomy, techniques, and clinical applications[J]. Indian J Anaesth, 2026, 70(1): 157-176.
[25] TRAN DQ, BOEZAART AP, NEAL JM.Fascial plane blocks: the next leap[J]. Reg Anesth Pain Med, 2021, 46(7): 568-569.
[26] HOTTA K.Fascial plane blocks: anatomical structures that affect the spread of local anesthetic[J]. J Anesth, 2019, 33(4): 493-494.
[26] KATZ J.Pre-emptive analgesia: importance of timing[J]. Can J Anaesth, 2001, 48(2): 105-114.
[27] RAGUPATHY R, GANESH PRABHU SC, THIYAGARAJAN D, et al.Opioid-free anaesthesia for laparoscopic surgeries: a prospective non-randomised study in a tertiary care hospital[J]. Indian J Anaesth, 2022, 66(3): 207-212.
[28] VRSAJKOV V, ILIĆ N, UVELIN A, et al.Erector spinae plane block reduces pain after laparoscopic cholecystectomy[J]. Anaesthesist, 2021, 70(Suppl 1): 48-52.
[29] TONG C, LI Y, DU F, et al.Ultrasound-guided external oblique intercostal plane block with ropivacaine for analgesia after open hepatectomy: a randomized controlled study[J]. Anesthesiology, 145(1): 37-47.
[30] SAHIN T, KAVAKLI AS, EREN E, et al.Ultrasound-guided external oblique intercostal plane block versus subcostal transversus abdominis plane block for postoperative analgesia in living liver donors: a prospective randomized trial[J]. J Clin Anesth, 2025, 106: 111971.
[31] KORKUSUZ M, BASARAN B, ET T, et al.Bilateral external oblique intercostal plane block (EOIPB) in patients undergoing laparoscopic cholecystectomy[J]. Saudi Med J, 2023, 44(10): 1037-1046.
[32] KAVAKLI AS, SAHIN T, KOC U, et al.Ultrasound-guided external oblique intercostal plane block for postoperative analgesia in laparoscopic sleeve gastrectomy: a prospective, randomized, controlled, patient and observer-blinded study[J]. Obes Surg, 2024, 34(5): 1505-1512.
[33] ERSKINE RN, WHITE L.A review of the external oblique intercostal plane block: a novel approach to analgesia for upper abdominal surgery[J]. J Clin Anesth, 2022, 82: 110953.
[34] TANG F, YANG Z, LIU Z, et al.Perioperative analgesic effect and safety of ultrasound-guided external oblique intercostal block and oblique subcostal transversus abdominis plane block in patients receiving laparoscopic radical gastrectomy[J]. Am J Transl Res, 2024, 16(11): 7126-7135.
[35] DIEU A, HUYNEN P, LAVAND' HOMME P, et al. Pain management after open liver resection: procedure-specific postoperative pain management (PROSPECT) recommendations[J]. Reg Anesth Pain Med, 2021, 46(5): 433-445.