Fascial plane blocks: the next leap

The analgesic contribution of external oblique intercostal block: Case reports of 3 different surgeries and 3 spectacular effects

INTRODUCTION

Abdominal wall blocks are frequently used due to the use of effective blocks, such as the transversus abdominis plane (TAP) block and the widespread use of ultrasound (US) imaging. A good knowledge of abdominal innervation is required for the use of abdominal wall blocks. We describe the extraordinary performance of external oblique intercostal (EOI) blocks in 3 different surgeries.

PATIENT CONCERNS, DIAGNOSIS AND INTERVENTIONS

Case 1: A man aged 30 to 35 was taken to the operating room for open liver surgery. After surgery, unilateral EOI block and bilateral TAP block were performed with the patient in the supine position, and a catheter was placed under the external oblique muscle. Postoperative analgesia was followed by patient-controlled analgesia (PCA) through the catheter. Case 2: A male patient aged 35 to 40 was taken to the operating room for laparoscopic liver surgery. After surgery, unilateral (EOI) block and bilateral TAP block were performed with the patient in the supine position. The patient received iv tramadol PCA (bolus dose 10 mg only, lockout 20 minutes). Case 3: A man aged 25 to 30 was taken to the operating room for laparoscopic bariatric surgery. After the surgery, bilateral EOI and bilateral rectal sheath blocks were performed with the patient in the supine position. The patient received iv tramadol PCA (bolus dose 10 mg only, lockout 20 minutes).

OUTCOMES

All patients had low NRS scores in the recovery unit and very low opioid consumption in the first 72 hours postoperatively. All were satisfied with the quality of analgesia.

CONCLUSION

We think that EOI block will come to occupy a significant place in upper abdominal analgesia, especially in obese patients, due to its wide innervation area and ease of application.

Regional and neuraxial anaesthesia techniques for spinal surgery: a scoping review

BACKGROUND

Whilst general anaesthesia is commonly used to undertake spine surgery, the use of neuraxial and peripheral regional anaesthesia techniques for intraoperative and postoperative analgesia is an evolving practice. Variations in practice have meant that it is difficult to know which modalities achieve optimal outcomes for patients undergoing spinal surgery. Our objective was to identify available evidence on the use of regional and neuraxial anaesthesia techniques for adult patients undergoing spinal surgery.

METHODS

This study was conducted using a framework for scoping reviews. This included a search of six databases searching for articles published since January 1980. We included studies that involved adult patients undergoing spinal surgery with regional or neuraxial techniques used as the primary anaesthesia method or as part of an analgesic strategy.

RESULTS

Seventy-eight articles were selected for final review. All original papers were included, including case reports, case series, clinical trials, or conference publications. We found that general anaesthesia remains the most common anaesthesia technique for this patient cohort. However, regional anaesthesia, especially non-neuraxial techniques such as fascial plane blocks, is an emerging practice and may have a role in terms of improving postoperative pain relief, quality of recovery, and patient satisfaction. In comparison with neuraxial techniques, the popularity of fascial plane blocks for spinal surgery has significantly increased since 2017.

CONCLUSIONS

Regional and neuraxial anaesthesia techniques have been used both to provide analgesia and anaesthesia for patients undergoing spinal surgery. Outcome metrics for the success of these techniques vary widely and more frequently use physiological outcome metrics more than patient-centred ones.