Bilateral External Oblique Intercostal Catheter for Post-operative Analgesia After Open Pancreaticoduodenectomy: A Case Report

Open pancreaticoduodenectomy, also known as Whipple surgery, is a complex and painful procedure that requires a multi-modal analgesic approach for successful post-operative rehabilitation and recovery. While thoracic epidural analgesia (TEA) remains the gold standard for pain relief after open upper abdominal surgery, it carries many risks that may outweigh the potential benefits of the technique. Furthermore, in laparoscopic converted to open pancreaticoduodenectomy cases, post-operative placement of a thoracic epidural catheter is inconvenient to the patient due to pain and positioning. The external oblique intercostal (EOI) block is a novel method that provides somatic analgesia to the upper abdomen. We present a case of bilateral EOI block with catheter insertion for post-operative analgesia in a patient who underwent laparoscopic converted to open Whipple surgery.

External Oblique Intercostal Block for Living Kidney Donor Open Nephrectomy: A Case Series

The external oblique intercostal (EOI) block is a novel regional technique that provides analgesia for upper abdominal incisions. We performed single-injection and continuous EOI blocks in living kidney donors who underwent open nephrectomy. In this case series, we report our experience with pain management using this technique in five patients at our centre. EOI block resulted in good pain relief in our patients. The median (IQR) numerical rating scale score was 3 (1-6) at rest immediately after the end of the surgery, predominantly visceral. We want to highlight the benefits regarding pain management of the association of EOI block with conventional therapy.

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.