Pain management is a fundamental part of the multimodal rehabilitation strategy for abdominal surgery. Currently, the laparoscopic approach to abdominal pathologies has modified the analgesic approach, favoring the use of abdominal wall blocks versus epidural analgesia. But, when the technique must be reconverted (technical problems, bleeding) we face an analgesic challenge. Since 2015 we have been conducting ultrasound-guided fascial blockade of the intercostal nerves at the level of the 8th rib for open cholecystectomy (modified BRILMA) in our hospital, having been incorporated bilaterally in the case of laparotomies performed in the upper abdomen since 2016. With the administration of the local anesthetic at this level blockage of the lateral and anterior cutaneous branches of the intercostal nerves 7-11, responsible for the innervation of the upper abdominal wall, is achieved. 
Encompassed in the multicenter study started in 2016 on the effectiveness of this blockade, we conducted a review of the postoperative analgesic techniques applied in the superior laparotomies of our medical center.
A total of 37 patients who met the inclusion criteria from January 2016 to May 2017 were registered: 15 in the analgesia group with modified BRILMA block, 17 with parenteral analgesia with morphine and 4 with epidural analgesia. We have seen that the modified BRILMA, uni or bilateral, has a higher quality of recovery (ambulation, oral tolerance) and better pain control (EVN <2 in motion) in patients with abdominal wall surgery (eventration and open cholecystectomy). This technique has not been shown superior to parenteral opioids in the control of pain, except in the absence of excessive sedation.

We can conclude that, although the sample size is small and more studies are needed, the modified BRILMA provides good control of postoperative pain in upper abdominal laparotomy, with fewer adverse events and better recovery, so it could be considered an option Analgesic in the multimodal approach in upper abdominal laparotomy

09 / Ultrasound-guided fascial block of the intercostal nerves, new multimodal approach in laparotomy of the upper abdomen a descriptive study.