Bilateral External Oblique Intercostal Plane Block Versus Intravenous Morphine for Rescue Pain Relief in Patients With Epidurals Following Upper Abdominal Surgeries: A Randomized Controlled Trial
Abstract
BACKGROUND
The management of postoperative pain after upper abdominal surgery is challenging. Thoracic epidural analgesia, though effective, has limitations, while intravenous (IV) morphine is associated with side effects. Ultrasound-guided external oblique intercostal block (EOIB) is an emerging regional technique for upper abdominal pain relief. We hypothesized that EOIB would provide superior pain relief to IV morphine in patients undergoing upper abdominal surgery. The main objective of the study was to compare pain relief from EOIB versus IV morphine as rescue analgesia in patients with moderate to severe pain despite an epidural after upper abdominal surgeries.
METHODS
This double-blinded, randomized controlled trial was conducted at a tertiary cancer hospital from January to November 2024. Patients aged ≥18 years undergoing upper abdominal surgery with pain on the numerical rating scale ≥4 despite epidural and IV paracetamol were randomized (1:1) to IV morphine (0.05 mg/kg, Arm A) or bilateral EOIB (0.1% bupivacaine 1 mL/kg and 4 mg dexamethasone, Arm B). The primary outcome was the total 24-hour morphine rescue requirement. Secondary outcomes included pain intensity difference (PID) at 0.5, 1, 4, 8, 12, 16, 20, and 24 hours, summated pain intensity difference at 8 and 24 hours (SPID), percentage PID in the first four hours, pain-free hours (PFH), and adverse events. Participants and outcome assessor nurses were blinded in the trial.
RESULTS
Of 101 screened patients,…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 101 participants or records.
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