A Comparative Study between External Oblique Intercostal Fascial Plane Block and Port-Site Infiltration for Post-operative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy

Background and aims: The supraumbilical region of the abdominal wall has a complex nerve supply with overlapping innervation of multiple intercostal nerves and their branches. Effective analgesia for surgical incision sites in this region can be challenging. Using ultrasound guidance, it is possible to block the anterior and lateral cutaneous branches of intercostal nerves, T6-T10, in the external oblique intercostal fascial plane. In this study, we compared the analgesic efficacy of the External Oblique Intercostal (EOI) fascial plane block with port-site infiltration in the post-operative period following laparoscopic cholecystectomy. 
Methods: Fifty ASA I and II patients posted for laparoscopic cholecystectomy were randomly assigned to receive ultrasound-guided EOI block (Group E) or Port-site infiltration of skin (Group P) with local anaesthetic solution. The primary outcome was the postoperative pain score, measured using the Visual Analog Scale (VAS). Secondary outcomes included the time to first analgesic requirement and the total requirement of opioids administered to provide pain relief in the first 24 hours post-operatively.
Results: Patients in Group E had significantly lower VAS scores at 2, 4, 8 and 24 hours post-operatively (p<0.001). The mean time to first rescue analgesic was significantly later in Group E (484.8 ± 170.51 min) than in Group P (340.8 ± 96 min), with p=0.0006. Total intravenous Tramadol (mg) consumption in 24 hours was also lower (152±71.41 versus 260±50, p<0.0001) in Group E than in Group P, respectively.
Conclusion: EOI block provides effective analgesia in laparoscopic cholecystectomy as observed by the reduced pain scores and reduced opioid analgesic consumption in the post-operative period.