Bilateral external oblique intercostal block combined with intravenous patient-controlled analgesia for multimodal analgesia after laparoscopic cholecystectomy: a single-center randomized controlled trial.

backgroundPostoperative pain after laparoscopic cholecystectomy (LC) remains common and peaks within 24 h. Opioid-based analgesia improves pain but can delay recovery, prompting opioid-sparing regional techniques within ERAS pathways.

objectiveTo evaluate whether adding bilateral ultrasound-guided external oblique intercostal plane block (EOIB) to standard intravenous patient-controlled analgesia (PCA) improves early analgesia and recovery after elective LC.

methodsIn a prospective, single-centre, randomized controlled parallel trial, 56 patients were randomized (1:1) to receive bilateral EOIB (n=28) or no regional block (control, n=28). All patients received standardised anesthesia and PCA with butorphanol. The primary outcome was total butorphanol consumption within 24 h postoperatively. Secondary outcomes included pain scores, Quality of Recovery at 24 h, time to first flatus, nausea and vomiting, intraoperative haemodynamic events, and length of hospital stay.

resultsEOIB significantly reduced 24 h butorphanol consumption [median 3.7 (IQR 3.2-4.8) mg vs. 7.2 (6.2-7.6) mg, equivalent to 18.5 vs. 36.0 mg intravenous morphine]. After adjustment, opioid consumption was 46.5% lower (95% CI 38.3-53.6; P<0.001). EOIB also increased QoR-15 at 24 h (median 140 vs. 131; P<0.001) and shortened time to first flatus (median 18 vs. 20 h; P=0.031). Cough-pain VRS scores were lower with a significant group-by-time interaction (P=0.013). Intraoperative haemodynamics did not differ, and PONV was numerically lower without statistical significance.

conclusionBilateral EOIB with standard PCA provides clear opioid-sparing effects after LC without increasing safety risks. STUDY REGISTRATION: ClinicalTrials.gov, NCT07332546.