External oblique intercostal plane block versus subcostal transversus abdominis plane block in paediatric upper abdominal oncological surgeries

Abstract

Background Regional blocks are increasingly used in paediatric anesthesia for effective perioperative analgesia, improving pain control and patient outcomes. Interfacial plane blocks are part of peripheral nerve blocks, offering low complication rates and enhancing multimodal analgesia for abdominal surgeries, reducing opioid use and aiding early recovery. Regional anaesthesia, especially in upper abdominal incisions, has significantly improved postoperative pain management in children, aiding in respiratory function and overall recovery. The advent of ultrasound guidance has further optimized block success by allowing precise needle placement and real-time monitoring of local anaesthetic spread. Techniques like the external oblique intercostal plane (EOI) and subcostal transversus abdominis plane (STAP) blocks have emerged as effective options with distinct advantages, such as ease of use and reliable outcomes. Objective This study aimed to compare the analgesic efficacy of the ultrasound-guided EOI block and the ultrasound-guided STAP block, using the Children’s Hospital Eastern Ontario Pain Scale (CHEOPS) for assessment. Patients and methods This prospective, randomized, double-blinded controlled study compared postoperative pain and analgesic needs between the EOI block and STAP block in paediatric patients undergoing upper abdominal oncological surgeries. Both blocks were performed under ultrasound guidance with bupivacaine 0.25% with a volume of 0.5 mg/kg. Postoperative analgesia was managed via intravenous paracetamol, with the need for rescue analgesia being guided by the CHEOPS score. The study will also monitor complications and assess analgesia quality at multiple time points. Results Statistical analysis of the data, obtained from the CHEOPS scores recorded at multiple time points (immediately postoperative, and at 2, 4, 8, 12, and 24 h), revealed no statistically significant difference in pain scores between the ultrasound-guided STAP block and the EOI block groups. Both groups showed a rise in pain scores at 8 h, with the highest pain scores observed at 24 h. The only notable difference between the two blocks was the ease of administration, with the EOI block being simpler to perform due to its more superficial fascial plane, compared with the deeper fascial plane of the STAP, which requires more manipulation for accurate block placement. Conclusion Both ultrasound-guided EOI plane block and STAP block proved to be equally effective in providing postoperative analgesia for paediatric patients who underwent upper abdominal surgery.