Opioid-Sparing Anesthesia for Open Total Pancreatectomy and Splenectomy Using the External Oblique Intercostal (EOI) Block: A Case Report

The external oblique intercostal (EOI) block is a relatively new fascial plane block that had been described for upper abdominal surgery. While it has had relatively good analgesia efficacy in the literature for various upper abdominal surgeries, it has yet to be proven to be effective as the sole analgesia technique. We present a 74-year-old Chinese female patient undergoing an open total pancreatectomy and splenectomy using the bilateral EOI block as the primary analgesia technique. A bilateral EOI block was performed preoperatively using 25 mL of 0.2% ropivacaine, and a catheter was inserted into the EOI plane for postoperative analgesia. No long-acting opioids were used intraoperatively. Twenty-five milliliters of 0.2% ropivacaine was supplemented through the catheter 30 minutes prior to the end of surgery. She emerged from anesthesia and reported only mild discomfort at the postanesthesia care unit (PACU). Postoperatively, the EOI catheters were kept for five days, and the patient only required the addition of regular 1 g of intravenous paracetamol every six hours to maintain effective analgesia. Only two doses of 50 mg intravenous tramadol were administered in the first 12 hours as rescue analgesia. We demonstrated that EOI block can provide effective analgesia for upper abdominal surgery, achieving a significant opioid-sparing effect intraoperatively and opioid reduction during the postoperative period.