Authors: Srinivasaraghavan, Nivedhyaa et al.
A & A Practice 19(7): e02019, July 2025. doi:10.1213/XAA.0000000000002019
This randomized controlled trial compared ultrasound-guided external oblique intercostal block (EOIB) with intravenous morphine as rescue analgesia in patients undergoing upper abdominal surgery who continued to experience moderate to severe pain despite an epidural and IV paracetamol. A total of 66 patients were randomized to either EOIB with bupivacaine/dexamethasone or IV morphine.
The EOIB group demonstrated significantly reduced 24-hour morphine requirements, higher pain-free hours, and better pain intensity differences in the early postoperative period compared with the morphine group. Summated pain intensity differences at both 8 and 24 hours also favored EOIB. Importantly, no significant adverse events were reported.
Overall, EOIB provided more effective and prolonged analgesia than IV morphine, reducing opioid consumption and extending periods of pain relief following upper abdominal surgery.
What you should know:
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EOIB significantly reduced the need for additional morphine within 24 hours.
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Patients receiving EOIB experienced longer pain-free periods compared with those on IV morphine.
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Early postoperative pain control (first four hours) was superior with EOIB.
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No major adverse events were associated with EOIB, suggesting it is a safe and effective adjunct to epidural analgesia.
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EOIB may represent a promising regional technique for improving recovery after upper abdominal surgery.
Thank you to A & A Practice for publishing this important study on improving postoperative pain management.