External Oblique Intercostal Plane Block (EOIPB) sebagai Tambahan Analgesia Multimodal Pasca Laparoskopi Kolesistektomi: Tinjauan Naratif
DOI:
https://doi.org/10.24843/JATI.2025.v01.i02.p07Kata Kunci:
External Oblique Intercostal Plane Block, Laparoscopic surgery, Visual Analog Scale (VAS), quality of recovery 15, Neutrophil to lymphocyte ratioAbstrak
Pendahuluan: Nyeri pascaoperasi, terutama setelah kolesistektomi laparoskopi, adalah masalah signifikan yang meningkatkan morbiditas dan memperpanjang masa rawat inap. Penanganan nyeri sering kali melibatkan opioid sistemik yang memiliki efek samping merugikan. Oleh karena itu, pendekatan analgesia alternatif yang minim opioid sangat dibutuhkan. Tinjauan naratif ini bertujuan mengevaluasi efektivitas External Oblique Intercostal Plane Block (EOIPB) sebagai tambahan analgesia multimodal pasca kolesistektomi laparoskopi, berfokus pada kualitas analgesia, pemulihan pasien, dan respons inflamasi sistemik.
Metode: Tinjauan naratif ini didasarkan pada penelusuran literatur terstruktur dari PubMed, Scopus, ScienceDirect, Cochrane Library, dan Google Scholar. Pencarian menggunakan kombinasi kata kunci seperti "external oblique intercostal plane block", "laparoscopic cholecystectomy", "postoperative pain", "quality of recovery", "neutrophil to lymphocyte ratio", dan "platelet to lymphocyte ratio". Publikasi dibatasi pada tahun 2019–2024, berbahasa Inggris atau Indonesia. Kriteria inklusi meliputi studi primer peer-reviewed (RCT, kohort, observasional) yang mengevaluasi EOIPB atau blok interfasial sebanding, serta melaporkan skor nyeri pascaoperasi, konsumsi opioid, skor quality of recovery (QoR-15), dan/atau nilai neutrophil to lymphocyte ratio (NLR) / platelet to lymphocyte ratio (PLR).
Hasil: EOIPB secara konsisten memperpanjang durasi analgesia, menurunkan intensitas nyeri dengan skor visual analog scale (VAS), dan mengurangi konsumsi opioid pascaoperasi secara signifikan. Studi juga menunjukkan profil keamanan EOIPB yang baik dengan insiden efek samping minimal. Bupivakain, agen anestesi lokal yang umum digunakan, tidak hanya memblok transmisi nyeri tetapi juga menunjukkan sifat anti-inflamasi. Meskipun demikian, terdapat heterogenitas dalam teknik dan jenis anestesi yang digunakan antar studi.
Kesimpulan: EOIPB adalah teknik blok interfasial yang efektif dan aman untuk manajemen nyeri pasca kolesistektomi laparoskopi, memberikan analgesia yang lebih baik dan mengurangi kebutuhan opioid. Namun, masih diperlukan penelitian lanjutan berskala besar, terstandarisasi, dan multicenter untuk memperkuat bukti ilmiah dan mengevaluasi dampak jangka panjangnya.
Referensi
1. Perlmutter B, Wynia E, McMichael J, Tu C, Scheman J, Simon R, et al. Effect of pre-operative opioid exposure on surgical outcomes in elective laparoscopic cholecystectomy. The American Journal of Surgery. 2022 Apr;223(4):764–9.
2. Hirohata R, Abe T, Amano H, Kobayashi T, Nakahara M, Ohdan H, et al. Laparoscopic cholecystectomy for acute cholecystitis in a patient with left-sided gallbladder: a case report. Surg Case Rep [Internet]. 2019;5(1):54. Available from: https://doi.org/10.1186/s40792-019-0614-9
3. Jones MW, Guay E, Deppen JG. Open Cholecystectomy. In: StatPearls [Internet]. Treasure Island (FL) : StatPearls Publishing; 2023.
4. Hassler KR, Collins JT, Philip K, Jones MW. Laparoscopic Cholecystectomy. StatPearls [Internet] Treasure Island (FL): StatPearls Publishing. 2024;
5. Cassuto J, Sinclair R, Bonderovic M. Anti-inflammatory properties of local anesthetics and their present and potential clinical implications. Acta Anaesthesiol Scand. 2006;50(3):265–82.
6. Şahin Karadil K, Gültekin A, Şahin A, Özkan Gürdal S, Yıldırım İ, Arar C. Comparison of the effect of erector spinae plane block for postoperative analgesia on neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in patients operated for breast cancer. The European Research Journal. 2024;10(4):388–97.
7. Domagalska M, Ciftsi B, Janusz P, Reysner T, Kolasinski J, Wieczorowska - Tobis K, et al. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) levels following erector spinae plane block (ESPB) in posterior lumbar decompression: a randomized, controlled trial. European Spine Journal. 2023;32(12):4192–9.
8. Köksal BG, Bollucuoğlu K, Şahin E, Bayram MG, Küçükosman G, Ayoğlu H. The effect of anesthesia methods on the neutrophil-lymphocyte ratio in patients undergoing forearm surgery: A monocentric and retrospective study. Medicine. 2024;103(43):e40290.
9. Chen Q, Liang J, Liang L, Liao Z, Yang B, Qi J. Neutrophil-to-Lymphocyte Ratio as an Indicator of Opioid-Induced Immunosuppression After Thoracoscopic Surgery: A Randomized Controlled Trial. J Pain Res. 2022 Jun;Volume 15:1855–62.
10. White L, Ji A. External oblique intercostal plane block for upper abdominal surgery: use in obese patients. Vol. 128, British Journal of Anaesthesia. Elsevier Ltd; 2022. p. e295–7.
11. Korkusuz M, Basaran B, Et T, Bilge A, Yarimoglu R, Yildirim H. Bilateral external oblique intercostal plane block (EOIPB) in patients undergoing laparoscopic cholecystectomy. Saudi Med J. 2023 Oct 30;44(10):1037–46.
12. Kavakli AS, Sahin T, Koc U, Karaveli A. Ultrasound-Guided External Oblique Intercostal Plane Block for Postoperative Analgesia in Laparoscopic Sleeve Gastrectomy: A Prospective, Randomized, Controlled, Patient and Observer-Blinded Study. Obes Surg. 2024 May 18;34(5):1505–12.
13. Myles PS, Shulman MA, Reilly J, Kasza J, Romero L. Measurement of quality of recovery after surgery using the 15-item quality of recovery scale: a systematic review and meta-analysis. Br J Anaesth. 2022 Jun;128(6):1029–39.
14. Chen S, Kandle PF, Murray I V., Fitzgerald LA, Sehdev JS. Physiology, Pain. StatPearls: Treasure Island (FL). 2023;
15. Liu S, Kelliher L. Physiology of pain—a narrative review on the pain pathway and its application in the pain management. Dig Med Res. 2022 Dec;5:56–56.
16. Chunduri A, Aggarwal AK. Multimodal Pain Management in Orthopedic Surgery. J Clin Med. 2022 Oct 28;11(21):6386.
17. Zhao Y fan, Yang H wen, Yang T shun, Xie W, Hu Z hua. TNF-α - mediated peripheral and central inflammation are associated with increased incidence of PND in acute postoperative pain. BMC Anesthesiol. 2021 Dec 17;21(1):79.
18. Ülger G, Baldemir R, Zengin M, Sazak H, Alagöz A. Is there a correlation between preoperative neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-monocyte ratios and postoperative pain in video-assisted thoracoscopic surgery? Medicine. 2022 May 27;101(21):e29472.
19. Malewicz-Oeck NM, Aulenkamp JL, Oeck S, Scheffzük C, Zahn PK, Hansen W, et al. The Relationship Between Chronic Postoperative Pain and Circulating Inflammatory Biomarkers (CC-Chemokine Ligand 5, Adiponectin, and Resistin) After Fracture-Related Surgery in Pain Chronification. Anesth Analg. 2025 Mar 25;
20. Toleska M, Dimitrovski A, Shosholcheva M, Kartalov A, Kuzmanovska B, Dimitrovska NT. Pain and Multimodal Analgesia in Laparoscopic Cholecystectomy. Prilozi. 2022 Jul 1;43(2):41–9.
21. Ozel ES, Kaya C, Turunc E, Ustun YB, Cebeci H, Dost B. Analgesic efficacy of the external oblique intercostal fascial plane block on postoperative acute pain in laparoscopic sleeve gastrectomy: a randomized controlled trial. Korean J Anesthesiol. 2025;159–70.
22. Shrey S, Sinha C, Kumar A, Kumar A, Kumar A, Nambiar S. Comparison of analgesic efficacy of ultrasound-guided external oblique intercostal plane block and subcostal transversus abdominis plane block in patients undergoing upper abdominal surgery: A randomised clinical study. Indian J Anaesth. 2024 Nov 1;68(11):965–70.
23. Shu B, Xu F, Zheng X, Zhang Y, Liu Q, Li S, et al. Change in perioperative neutrophil-lymphocyte ratio as a potential predictive biomarker for chronic postsurgical pain and quality of life: an ambispective observational cohort study. Front Immunol. 2023;14(April):1–10.
24. Boruah P, Gupa B, Kumar A, Bhadoria AS, Chandra H, Kumari R. Effects of Different Anesthetic Techniques on Neutrophil Lymphocyte Ratio and Monocyte Lymphocyte Ratio in Patients Undergoing Major Non-cardiac Surgery: A Prospective, Single-blind, Randomized Study. Bali Journal of Anesthesiology. 2023;7(3):188–9.
25. Mo K, Kong W, Chen J, Zhao S, Zhu Q. Preoperative Bilateral External Oblique Intercostal Plus Rectus Sheath Block for Postoperative Pain Management Following Laparoscopic Cholecystectomy. Clin J Pain. 2024 Oct;40(10):601–6.
26. Ciftci B, Alver S, Gölboyu BE, Haksal MC, Tulgar S, De Cassai A, et al. A Comparison of Two Fascial Plane Blocks for Abdominal Analgesia in Laparoscopic Cholecystectomy Surgery (M-TAPA vs. External Oblique Intercostal Plane Block): A Prospective Randomized Study. J Clin Med. 2025 Apr 28;14(9):3050.
27. Gangadhar V, Gupta A, Saini S. Comparison of analgesic efficacy of combined external oblique intercostal and rectus sheath block with local infiltration analgesia at port site in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial. Anesth Pain Med (Seoul). 2024 Jul 31;19(3):247–55.
28. Elsharkawy H, Kolli S, Soliman LM, Seif J, Drake RL, Mariano ER, et al. The External Oblique Intercostal Block: Anatomic Evaluation and Case Series. Pain Medicine. 2021 Nov 26;22(11):2436–42.
Unduhan
Diterbitkan
Terbitan
Bagian
Lisensi
Hak Cipta (c) 2025 David Rendra Mahardika, Made Agus Kresna Sucandra, Tjokorda Gde Agung Senapathi (Author)
Artikel ini berlisensi Creative Commons Attribution 4.0 International License.
