Authors: Srinivasaraghavan N et al.
A & A Practice 19(7):e02019, July 2025. | DOI: 10.1213/XAA.0000000000002019
This randomized controlled trial compared bilateral external oblique intercostal plane block (EOIB) versus intravenous (IV) morphine for rescue analgesia in patients who continued to experience moderate to severe pain after upper abdominal surgery despite epidural analgesia. Conducted in a tertiary cancer hospital, 66 patients were randomized to receive either EOIB (0.1% bupivacaine with dexamethasone) or IV morphine (0.05 mg/kg).
The EOIB group demonstrated significantly lower 24-hour morphine consumption [median 0 mg (IQR 0–1.5)] compared to the morphine group [2.5 mg (IQR 1–6.1); P = .006]. Additionally, EOIB provided better summated pain intensity differences (SPID) at both 8 and 24 hours and resulted in a greater percentage of pain relief in the first four hours. Pain-free hours were also significantly higher in the EOIB group (median 4 hours) compared to the morphine group (median 0 hours). Importantly, two EOIB patients remained pain-free (NRS = 0) for the entire 24-hour period. No significant adverse events were reported.
The study concludes that EOIB offers superior and longer-lasting analgesia than IV morphine in patients with breakthrough pain following upper abdominal surgeries, while also reducing opioid consumption.
References:
Authors: Srinivasaraghavan N et al. 2025.
A & A Practice 19(7):e02019. doi:10.1213/XAA.0000000000002019
Thank you to the International Anesthesia Research Society for allowing us to share this article and highlight their journal.