Date of Award
8-14-2026
Document Type
Capstone
Degree Name
Doctor of Nursing Practice (DNP)
School Name
Donna and Allan Lansing School of Nursing and Health Sciences
Department
Nursing
Major Advisor
Dr. Carly Mitchell
Second Advisor
Dr. Chris Webb
Abstract
Effective postoperative pain management for upper abdominal surgery remains a challenge despite advances in regional anesthesia. Although the subcostal transversus abdominis plane (TAP) block is commonly used, it may provide inconsistent dermatomal coverage for supraumbilical incisions. The external oblique intercostal (EOI) block has emerged as an alternative technique that may provide broader thoracoabdominal nerve coverage and improved postoperative analgesia. This scholarly project aimed to develop an evidence-based clinical decision-support guideline to assist anesthesia providers in selecting the most appropriate regional anesthesia technique for patients undergoing upper abdominal surgery. A comprehensive review of randomized controlled trials, cadaveric studies, and clinical case reports comparing the EOI and subcostal TAP blocks was conducted. Evidence was synthesized to evaluate dermatomal coverage, postoperative pain scores, opioid consumption, duration of analgesia, and safety, and the findings informed development of the decision-support guideline. Most studies demonstrated that the EOI block provided broader and more consistent sensory coverage of the T6–T10 dermatomes than the subcostal TAP block. Several studies also reported lower postoperative pain scores, prolonged time to first rescue analgesia, and reduced opioid requirements following EOI blocks, while cadaveric studies supported these findings by demonstrating spread of local anesthetic to both the anterior and lateral cutaneous branches of the thoracoabdominal nerves. However, some studies found no significant differences in analgesic outcomes. Overall, both the EOI and subcostal TAP blocks appear to be safe and effective options for postoperative analgesia. The resulting evidence-based decision-support guideline provides anesthesia providers with a practical resource for evidence-informed block selection while highlighting the need for additional high-quality comparative research.
Recommended Citation
Osborne, Michael; Jones, Sophie; and Moseley, Tim, "External Oblique Intercostal and Subcostal Transversus Abdominis Plane Blocks for Upper Abdominal Surgeries" (2026). Graduate Theses, Dissertations, and Capstones. 229.
https://scholarworks.bellarmine.edu/tdc/229
Included in
Anesthesia and Analgesia Commons, Anesthesiology Commons, Other Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons, Other Medical Specialties Commons, Other Nursing Commons, Surgery Commons