Comparison of External Oblique and Rectus Abdominis Plane (EXORA) block with Subcostal Transverse Abdominis Plane (TAP) Block for post operative Analgesia in Laparoscopic Cholecystectomy

Comparison of EXORA Block and Subcostal TAP Block for Postoperative Analgesia in Laparoscopic Cholecystectomy.

In recent years, regional anaesthesia, particularly abdominal wall blocks, has become a key component of multimodal analgesia due to their opioid-sparing effects and efficacy in managing postoperative pain. One such technique, the subcostal transversus abdominis plane (TAP) block, involves injecting local anaesthetic between the internal oblique and transversus abdominis muscles to target the anterior branches of thoracic spinal nerves (T6–T12). It has demonstrated effectiveness in providing analgesia for upper abdominal surgeries, including laparoscopic gallbladder removal, by covering the dermatomes linked to surgical and visceral pain in that area.

More recently, a novel block known as the External Oblique and Rectus Abdominis Plane (EXORA) block has been introduced. This technique targets the interfascial plane between the external oblique and rectus abdominis muscles, aiming to block the anterior cutaneous branches of thoracoabdominal nerves (T6–T9) that innervate the gallbladder and upper abdominal wall. The local anaesthetic is administered between these two muscles to potentially offer more localized pain relief in the upper abdominal region. Although promising, there is currently limited clinical research directly comparing its effectiveness to that of the subcostal TAP block.

The present study seeks to compare EXORA and subcostal TAP blocks in the context of postoperative pain relief, need for additional analgesics, and overall patient satisfaction following laparoscopic cholecystectomy. This comparison aims to determine whether EXORA block can be considered a viable or even superior alternative to the more established subcostal TAP technique in routine surgical practice.