202406170359
Status:
Tags: Regional
External oblique intercostal plane block
2019 by Elsharkawy et al.
Anatomy
- Anterolateral upper abd wall innervation : ventral rami of T6 - T10
- Two key branches of intercostal nerves
- Lateral cutaneous
- Anterior cutaneous
- Two key branches of intercostal nerves
- External oblique
- Thin broad muscle
- Spanning both thorax & abd
- Originates on external surfaces of ribs 5-12
- Form digitations w/ serratus anterior & latissimus dorsi
- Courses anteriorly from midclavicular line à form aponeurosis à becomes part of ant rectus sheath
- Spinal nerves T6 - T9
- Emerge from costal margin into plane btw IO & TA
- Then enter lateral border of rectus sheath à terminate as anterior cutaneous branches
Benefits
- Superficial
- Ease to perform
- Safe in anticoagulated pt
- Less affected by body habitus
- <4cm deep
- Not interfere w/ surgical incision
- USG image not disrupted by surgical incision
- Performed supine
Landmark
- Anterior axillary line
- Level of xiphoid process
- → 6th rib
- EO confirmed by:
- Tracing to subcostal TAP view
- Move probe laterally to visualise junction btw serratus anterior & EO
- possibility of landmark technique
LA dose
- Bolus: 15 - 30ml
- Infusion 10 - 15ml programmed intermittent bolus Q2-3H