Authors: Tong C et al.
Journal: Anesthesiology, December 29, 2025. DOI: 10.1097/ALN.0000000000005846
Summary
This randomized controlled trial evaluated the analgesic efficacy and safety of an ultrasound-guided external oblique intercostal (EOI) plane block with ropivacaine in patients undergoing elective open hepatectomy. The study addressed an important clinical gap for patients in whom epidural or paravertebral analgesia may be undesirable or contraindicated, particularly due to concerns about perioperative coagulopathy.
Seventy adult patients were randomized to receive either an EOI plane block with 30 ml of 0.375% ropivacaine or an equivalent volume of saline, in addition to standard patient-controlled intravenous analgesia. The primary outcome was postoperative opioid consumption within the first 24 hours, expressed as intravenous morphine equivalents.
Patients receiving the EOI block demonstrated significantly lower opioid requirements at 24 hours, with progressively greater reductions at 36 and 48 hours postoperatively. Intraoperative opioid use was also reduced in the EOI group, and patients experienced longer durations before requiring rescue analgesia. Resting pain scores were consistently lower in the block group, although pain with coughing did not differ significantly between groups.
Importantly, no EOI-related complications were observed, and there were no differences in quality-of-recovery scores, length of hospital stay, or rates of chronic pain at three months. Sensory assessment confirmed reliable dermatomal coverage centered at T6–T8 with extension across the upper abdominal wall.
Overall, the study supports the EOI plane block as an effective and safe component of multimodal analgesia for open hepatectomy, offering meaningful opioid-sparing benefits without added risk.
Key Points
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Preoperative ultrasound-guided EOI plane block significantly reduces postoperative opioid consumption after open hepatectomy.
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Opioid-sparing effects increased over the first 48 postoperative hours.
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Intraoperative opioid requirements were also reduced with EOI block.
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Resting pain scores improved, with longer time to first rescue analgesia.
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No block-related complications were observed.
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EOI block may be a valuable alternative when neuraxial techniques are contraindicated.
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