External Oblique Intercostal Plane Block Versus Erector Spinae Plane Block in Paediatric Upper Abdominal Surgeries

Paediatric nerve blocks are increasingly recognized as new standard for managing pain in children. The advantages of regional anesthesia in this population include enhanced operating conditions, expedited recovery of bowel function, and reduced postoperative pain.

The caudal epidural block remains the most used method; however, the external oblique intercostal block, a novel technique involves administering local anesthesia deep to the external oblique muscle at the sixth intercostal space, thereby blocking thoracoabdominal nerves from T6 to T10. This technique offers several advantages, including straightforward anatomy, a single muscle strip that is easily identifiable even in obese patients, a bony backstop, and an easily expandable fascial plane that can accommodate a catheter.

The erector spinae plane block involves injecting local anesthetic into the fascial plane beneath the erector spinae muscle at the tip of the vertebral transverse process. This allows the local anesthetic to spread in the craniocaudal fascial plane.

Inclusion criteria

• Children aged between 6 and 12 years of both sex.
• Patients with the American Society of Anesthesiologists (ASA) physical status I/II.
• Patients undergoing upper abdominal surgeries involving upper abdominal incisions.

Exclusion criteria

• Guardian refusal.
• Allergy to local anesthetics.
• Surgical procedures exceeding 3 hours.
• Infection at the area planned for the block injection.
• Prolonged opioid medication.
• Patients preoperatively medicated by Beta blockers