Analgesic Efficacy of External Oblique Intercostal Block in Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis

Abstract

Background Laparoscopic sleeve gastrectomy (LSG) is associated with significant postoperative pain despite being minimally invasive. External oblique intercostal block (EOIB) has emerged as a novel regional anesthesia technique targeting upper abdominal wall innervation. In this systematic review and meta-analysis with trial sequential analysis (TSA), we aimed to systematically assess the analgesic efficacy of EOIB in patients undergoing LSG, focusing on opioid consumption, pain scores, rescue analgesia use, and recovery outcomes. Methods We systematically searched PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science (from inception to until 22 May 2025). The primary outcome was 24-h opioid consumption. Secondary outcomes included pain scores, postoperative nausea and vomiting (PONV), and rescue analgesic use. Risk of bias was assessed using RoB 2, and the certainty of evidence was evaluated using the GRADE approach. Results Four RCTs (n = 249) were included. EOIB significantly reduced 24-h morphine milligram equivalent (MME) consumption (MD - 12.76 mg; 95% CI - 16.76 to - 8.77; p < 0.001). EOIB also lowered postoperative pain scores and decreased rescue analgesic use (OR 0.20; 95% CI 0.09-0.45). PONV incidence was reduced, but not statistically significant. TSA demonstrated that the current evidence is sufficient to confirm a statistically significant effect, with no further trials required. Conclusions EOIB appears to be a safe and effective component of multimodal analgesia in LSG, with TSA results supporting the robustness of current evidence.