49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

External Oblique Intercostal Fascial Plane Block for Pain Control after LVAD implantation

Introduction

26 million patients globally with heart failure requiring LVAD support
Sternotomy, driveline, thoracostomy tubes main source of pain
Pain control is critical to promote respiratory mechanics
Obesity, anticoagulation status, position can pose additional challenges
Alternative: EOI fascial plane block + superficial parasternal intercostal plane block (SPIP)

Case Report

53 y/o M with HFrEF <15%, biventricular non-ischemic cardiomyopathy presented with cardiogenic shock

LVAD placed with midline sternotomy approach, 2 thoracostomy tubes, drive line, and pigtail.
POD 1: Multimodal pain regime
POD 2: Single-shot L EOI block
POD 3: Repeat L EOI + b/l SPIP block
Decreased opioid consumptions, participation in physical therapy, ambulation, incentive spirometry and atelectasis

Figure 1: Ultrasound image of external oblique intercostal plane block

Figure 2A: POD1 CXR demonstrates small R PTX, mild basilar opacities

Figure 2B: POD3 demonstration resolution of R PTX, decreased basilar opacities “likely resolving atelectasis”

Figure 3: Narcotic usage by day. Of note, all narcotics consumed on POD 2 and 3 were before the placement of the nerve blocks with no further narcotic needs after the block each day.

Discussion/Conclusion

EOI fascial plane block targets anterior and lateral cutaneous branches, providing consistent coverage for upper lateral abdominal wall.
Easily performed in the supine position, superficial, and addresses concerns about anticoagulation and body habitus.
Minimizing opioid use crucial in LVAD patients due to heightened respiratory concerns.

49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

EXTERNAL OBLIQUE INTERCOSTAL FASCIAL PLANE BLOCK FOR PAIN CONTROL AFTER LVAD IMPLANTATION

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