Ultrasound-Guided External Oblique Intercostal Fascial Plane Block for Postoperative Analgesia

Background: After abdominal wall surgery, improved recovery largely depends on effective postoperative analgesia.  Currently, there is no clinical data to support the clinical efficacy of ultrasound-guided external oblique intercostal fascial plane block (EOIPB), a novel regional anesthesia technique that provides anterior and lateral abdominal wall analgesia.
Objectives: This study aimed to evaluate the analgesic efficacy and safety of ultrasound-guided EOIPB in patients undergoing paraumbilical hernioplasty.
Patients and Methods:  This prospective single-arm study included 30 adult patients (ASA physical status I–II) scheduled for elective paraumbilical hernioplasty under general anesthesia. All patients received bilateral ultrasound-guided EOIPB with 20 mL of local anesthetic on each side (10mL 0.5% bupivacaine, 5mL 2% lidocaine, and 5 mL of normal saline). Postoperative analgesia consisted of paracetamol and ketorolac, with morphine administered if the Numeric Rating Scale (NRS score) exceeded 3. The primary outcomes included 24-hour morphine consumption; secondary outcomes were serial NRS pain scores at rest and during coughing, hemodynamic parameters, and the incidence of postoperative nausea and vomiting (PONV).
Results: Patients maintained low pain scores at rest and during coughing with significant improvement over time. The mean cumulative morphine requirement was 10.3 ± 4.0 mg in the first 24 hours, while intraoperative fentanyl consumption averaged 48.0±20.6 µg. Hemodynamic parameters demonstrated significant but clinically acceptable variability, with transient reductions in heart rate and mean arterial pressure observed during the early postoperative period. PONV occurred in 5 patients (16.7%), all of whom were managed successfully with antiemetics.
Conclusion: Ultrasound-guided EOIPB is a safe and effective technique for postoperative analgesia following paraumbilical hernioplasty. It provides sustained pain relief, reduces opioid consumption, maintains hemodynamic stability, and is associated with a low incidence of complications.