Nociception Level-Guided Multimodal Analgesia with External Oblique Intercostal Plane Block in Laparoscopic Cholecystectomy.
Bilge Aslan, Sena Saricaoglu Oktem, Aysun Ersen Yungul et al.
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In 30 seconds
This double-blind randomized controlled trial compared nociception level (NOL)-guided multimodal analgesia (MMA) incorporating an external oblique intercostal plane (EOIP) block with intravenous dexketoprofen alone in 62 ASA I–II adults undergoing elective laparoscopic cholecystectomy. Remifentanil was titrated to predefined NOL thresholds in both groups. During pneumoperitoneum, NOL values were lower with MMA (mean difference: 13.51; 95% CI: 4.68-22.34; p < 0.004), and emergence pain scores were also reduced. Total remifentanil consumption did not differ, while sevoflurane requirements and extubation times were lower with MMA.
Key findings
- During pneumoperitoneum, NOL values were lower with MMA (mean difference: 13.51; 95% CI: 4.68-22.34; p < 0.004).
- Emergence pain scores were lower with MMA (p < 0.001), but total remifentanil consumption did not differ between groups.
- Sevoflurane requirements and extubation times were lower with MMA; postoperative opioid rescue, nausea/vomiting, and other adverse events did not differ.
Why it matters
The findings suggest that combining NOL-guided opioid titration with EOIP block and adjunctive analgesia can improve intraoperative nociceptive control and early emergence pain in laparoscopic cholecystectomy without increasing remifentanil use. The lower sevoflurane requirements and extubation times may also be relevant to anesthetic management, although confirmation in larger studies is needed.
What to keep in mind
The trial included 62 patients at a single study setting, and the investigator performing the EOIP block was unblinded. The authors state that larger multicenter studies are warranted.