• Hesham Elsharkawy, Sree Kolli, Loran Mounir Soliman, John Seif, Richard L Drake, Edward R Mariano, and Kariem El-Boghdadly.
• Department of Anesthesiology, Pain and Healing Center, MetroHealth, Case Western Reserve University, Cleveland, Ohio, USA.
• Pain Med. 2021 Nov 26; 22 (11): 2436-2442.

Study ObjectiveWe report a modified block technique aimed at obtaining upper midline and lateral abdominal wall analgesia: the external oblique intercostal (EOI) block.DesignA cadaveric study and retrospective cohort study assessing the potential analgesic effect of the EOI block.SettingCadaver lab and operating room.PatientsTwo unembalmed cadavers and 22 patients.InterventionsBilateral ultrasound-guided EOI blocks on cadavers with 29 mL of bupivacaine 0.25% with 1 mL of India ink; single-injection or continuous EOI blocks in patients.MeasurementsDye spread in cadavers and loss of cutaneous sensation in patients.Main ResultsIn the cadaveric specimens, we identified consistent staining of both lateral and anterior branches of intercostal nerves from T7 to T10. We also found consistent dermatomal sensory blockade of T6-T10 at the anterior axillary line and T6-T9 at the midline in patients receiving the EOI block.ConclusionsWe demonstrate the potential mechanism of this technique with a cadaveric study that shows consistent staining of both lateral and anterior branches of intercostal nerves T7-T10. Patients who received this block exhibited consistent dermatomal sensory blockade of T6-T10 at the anterior axillary line and T6-T9 at the midline. This block can be used in multiple clinical settings for upper abdominal wall analgesia.© The Author(s) 2021. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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