P115 External oblique intercostal plane block with continuous catheter for congenital diaphragmatic hernia repair in a 24-hour-old neonate: a case report

<h3>Application for ESRA Abstract Prizes</h3> : I apply as an Anesthesiologist (Aged 35 years old or less) <h3>Background and Aims</h3> Congenital diaphragmatic hernia (CDH) is a life-threatening neonatal condition requiring early surgical intervention. Providing effective analgesia is challenging due to systemic opioid limitations and the technical demands of neuraxial or regional techniques in neonates. We present a case using external oblique intercostal plane block (EOIB) with continuous catheter for analgesia in a neonate undergoing Bochdalek hernia repair. <h3>Methods</h3> A term male neonate (39 weeks, 3100 g), intubated after birth, was admitted to the NICU (figure 1). At 24 hours of life, he was scheduled for Bochdalek hernia repair and was already receiving continuous fentanyl infusion (2 mcg/kg/h) for sedation. General anaesthesia was induced with sevoflurane in an oxygen-air mixture, and neuromuscular blockade using 1 mg/kg rocuronium. Before incision, a left EOIB was performed in the supine position using a linear hockey stick ultrasound probe at the 5–6th intercostal space. After hydrodissection, 4 mL 0.125% bupivacaine was injected between the external oblique and intercostal muscles, and a catheter was advanced 3 cm beyond the needle tip for postoperative analgesia (figure 2). No additional opioids were administered. <h3>Results</h3> Postoperatively, fentanyl infusion was tapered, and sedation was maintained with midazolam. The first bolus (1.5 mL 0.1% bupivacaine) was administered via the catheter at hour 14, with subsequent boluses provided as needed. The total daily bupivacaine dose remained below 2 mg/kg. The patient remained hemodynamically stable, with adequate respiratory function and no signs of pain or distress. Extubation was achieved at hour 38 without complications. No block- or catheter-related issues occurred. <h3>Conclusions</h3> While continuous epidural and erector spinae plane blocks have been reported in CDH surgeries, (1,2), EOIB offers a less invasive, supine-accessible alternative, minimizing procedural risk and patient repositioning. EOIB with continuous catheterisation is a promising opioid-sparing analgesic option for neonatal CDH repair. Further studies are needed to define its role and establish optimal dosing protocols.