Unilateral rhomboid intercostal and subserratus plane block application for analgesia after laparoscopic cholecystectomy surgery :a quasi-experimental study

Rhomboid Intercostal and Subserratus Plane Block for Acute Pain Management after Abdominal Surgeries: A Narrative Review

PURPOSE OF REVIEW

The rhomboid intercostal and subserratus plane (RISS) block is an effective, safer alternative for managing postoperative acute pain following abdominal surgeries. The RISS block offers several advantages over traditional approaches, including reduced incidence of puncture-related complications, lower rates of systemic opioid consumption, and more consistent analgesic coverage of lower thoracic dermatomes.

RECENT FINDINGS

Despite a favorable safety profile, the RISS block carries potential risks, such as pneumothorax and local anesthetic systemic toxicity, particularly when long-acting anesthetics such as bupivacaine or ropivacaine are used. Careful administration with ultrasound guidance minimizes these risks, enhancing patient safety. Compared to epidural and paravertebral blocks, RISS is associated with fewer instances of nerve damage, hemodynamic instability, and bleeding. Research suggests that RISS not only improves postoperative pain scores, but also extends duration of analgesic effect, reducing total opioid use by nearly 40%.

CONCLUSION

Future directions include clinical trials to validate efficacy across diverse patient populations, comparative studies with other regional blocks, and evaluations of long-term outcomes. Expanding our understanding of RISS block application may help advance multimodal pain management protocols, underscoring potential to improve recovery, reduce opioid dependency, and elevate patient quality of life in postoperative settings.

Ultrasound-Guided Continuous Rhomboid Intercostal and Sub-Serratus Plane Block Comparison of Thoracoscopic Intercostal Nerve Block After Thoracoscopic Surgery: A Prospective Randomized Controlled Study

Purpose

Thoracic surgery is among the most painful surgeries, postoperative pain can lead to a poor prognosis. This study aimed to explore the analgesic effect of ultrasound-guided continuous rhomboid intercostal and sub-serratus (RISS) plane block Comparison of thoracoscopic intercostal nerve block (ICNB) on postoperative pain management and recovery in patients who underwent Video-Assisted Thoracic Surgery (VATS) Lobectomy.

Methods

This prospective randomized controlled study enrolled patients after VATS Lobectomy who received ultrasound-guided continuous RISS plane block (RISS group) or ICNB (Control group) for postoperative pain. The primary outcome was the visual analogue scale (VAS) score. The secondary outcomes included non-invasive blood pressure (NIBP), heart rate (HR), the time to ambulation after surgery, the timing of drain removal, and the duration of postoperative hospitalization.

Results

A total of 98 participants were collected (53.08 ± 13.63; 43 (43.88%) males); each group included 49 patients. The RISS group displayed significantly lower visual analogue scale (VAS) scores during rest and when coughing at postoperative 12, 24, and 48h compared to the Control group (P < 0.001). The total consumption of sufentanil and remifentanil was smaller in the RISS group than in the control group. The NIBP,HR in the RISS group were significantly lower than in the Control group at immediately after skin incision (T1), upon entering the thoracic cavity (T2), 5 min after entering the thoracic cavity (T3) (P < 0.001). The patients in the RISS group were more likely to exhibit a shorter time to the first postoperative ambulation compared to the Control group (8.84 ± 2.87,15.43 ± 4.50, P < 0.001).

Conclusion

Continuous RISS may be a safe and effective strategy for postoperative pain management after thoracoscopic surgery.

Effectiveness of ultrasound-guided rhomboid intercostal and sub-serratus block for perioperative analgesia in male patients undergoing combined power-assisted liposuction with pull-through excision of the gland for breast definition and reshaping

BACKGROUND

The newly introduced ultrasound guided interfacial rhomboid intercostal and sub-serratus (RISS) block technique demonstrated promising efficacy in managing perioperative pain among patients undergoing abdominal and thoracic procedures. Thus, this study investigated the efficiency of bilateral ultrasound-guided RISS (US-RISS) as a perioperative pain control technique in male subjects receiving gynecomastia surgery.

METHODS

This prospective randomized study involved sixty patients who underwent gynecomastia surgery. Individuals were randomly divided into two groups: the RISS group (N.=30) and the control group (N.=30). After anesthesia induction, the patients received bilateral US-RISS using 40 mL of 0.25% levobupivacaine, or conventional intravenous analgesia with no intervention, respectively. The primary outcome was the overall morphine consumption in 24 hours, and the secondary endpoints involved the time elapsed till rescue analgesia was requested, the quality of recovery after 24 hours and side effects' incidence.

RESULTS

Morphine consumption was noticeably decreased in the RISS group compared to the control group, with 14.07±4.91 mg and 35.83±1.70 mg mean values, respectively (P<0.001). Furthermore, in the RISS group, the initial rescue analgesia request occurred significantly later than in the control group, with mean values of 15.58±1.41 hours and 0.96±0.63 hours, respectively (P<0.001). Additionally, within the RISS group, there was a high quality of recovery observed, with a low incidence of opioid-related adverse events in comparison to the control group.

CONCLUSIONS

Bilateral US-RISS block is a beneficial intervention in gynecomastia surgery for pain management and improves the quality of recovery.

Bilateral external oblique intercostal plane block (EOIPB) in patients undergoing laparoscopic cholecystectomy: A randomized controlled trial

OBJECTIVES

To measure tramadol intake in the first 24 hours post-surgery. In addition, pain scores and quality of recovery were evaluated as secondary outcomes.

METHODS

A total of 80 adult patients scheduled for laparoscopic cholecystectomy were randomized into 2 groups (with and without external oblique intercostal plane block [EOIPB]). Control group of patients received standard multimodal analgesia, EOIPB was applied on each side to patients in EOIPB group in addition to multimodal analgesia. The primary outcome was to evaluate tramadol consumption at postoperative 24 hours. Secondary outcomes were evaluating the Numeric Rating Scale (NRS) scores, postoperative Quality of Recovery score (QoR-15), sedation score, the incidence of nausea and vomiting, and antiemetic consumption.

RESULTS

In EOIPB group, median (Q1, Q3) tramadol consumption values for 24 hours (0 [0,50] mg) were found to be significantly lower than the control group (50 [50,100] mg) (median difference -50) (p<0.001). NRS values during rest and motion were lower in EOIPB group compared to the control group at all measurement points within 24 hours (p<0.05). The total QoR-15 scores were significantly higher in EOIPB group compared to the control group (p<0.001). No differences were detected in other secondary outcome parameters.

CONCLUSION

External oblique intercostal plane block resulted in less postoperative tramadol consumption. However, there were no minimal clinically important differences about postoperative opioid consumption. On the other hand, compared to multimodal analgesia addition of EOIPB improved overall QoR-15 scores at postoperative 24 hours.Clinical Trial Reg. No.: NCT05536557.