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. 2020 Apr-Jun;14(2):226-232.
doi: 10.4103/aer.AER_41_20. Epub 2020 Oct 12.

Ultrasound-guided Bilateral Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Ruchi Verma  1 , Divya Srivastava  1 , Ruchi Saxena  2 , Tapas K Singh  1 , Devendra Gupta  1 , Anil Agarwal  1 , Prabhakar Mishra  3
Affiliations

Ultrasound-guided Bilateral Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Ruchi Verma et al. Anesth Essays Res. 2020 Apr-Jun.

Abstract

Background: Laparoscopic cholecystectomy (LC) is associated with moderate-to-severe pain in immediate postoperative period. Some patients even suffer from prolonged pain long after surgery.

Aims: The aim of present study is to determine the efficacy of ultrasound-guided bilateral erector spinae plane block (ESPB) in patients undergoing LC, time to ambulation after surgery, and incidence of prolonged pain up to 6 months later.

Settings and design: This was a double-blinded prospective randomized controlled trial.

Materials and methods: Eighty-five adults posted for elective LC were randomized to receive bilateral ESPB at T7 level with either 20 mL of 0.375% ropivacaine or 20 mL normal saline. Postoperative static and dynamic pain score as per the visual analog scale (VAS), intraoperative requirement of fentanyl, postoperative use of diclofenac, time to ambulation after surgery, and presence of any pain after surgery were noted.

Statistical analysis: Independent t-test and Mann-Whitney U-test were used for quantitative data, while Chi-square test was used for comparing qualitative data.

Results: Static and dynamic VAS scores were significantly lower in ESPB group (P < 0.05). Intraoperative fentanyl requirement (165 ± 30.72 - ESPB, 180.95 ± 29.12 - controls, P = 0.020) and number of patients requiring diclofenac (28/42 - ESPB, 37/42 - controls, P = 0.019) were lower, while number of patients ambulating by 4 hours (20/42 - ESPB, 9/42 - control, P = 0.012) were higher in ESPB group. Patients suffering from pain at 1 week (22/42 - ESPB and 34/42 - control, P = 0.005) and 1 month (9/42 - ESPB and 13/42 - control, P = 0.207) were lower in ESPB group.

Conclusion: ESPB provides effective analgesia and early ambulation after LC. The benefit extends to 1 week thereafter.

Keywords: Ambulation; chronic pain; erector spinae plane block; laparoscopic cholecystectomy.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Consort flow chart
Figure 2
Figure 2
Ultrasonographic images of erector spinae plane block. (a) Sonoanatomy before performing the block. (b) During the block. (c) After completion of the block with needle in situ. TP = Transverse process, ESM = Erector spinae muscle, RM = Rhomboid muscle, TM = Trapezius muscle, PVS = Paravertebral space, LA = Local anesthetic, P = Pleura, Cr = Cranial, Cd = Caudal, Arrows = Showing needle trajectory
Figure 3
Figure 3
Trend of the static and dynamic pain score at various time points. Median visual analog scale scores at rest (SVAS) and on coughing (DVAS) for erector spinae plane block and control group at different time points. Repeated measures analysis done by Friedman test. In ESPB group all values of SVAS and DVAS (except at 1 hour) were less than or equal to clinically significant value of 4. SVAS = Static VAS score, DVAS = Dynamic VAS score
Figure 4
Figure 4
Ambulation at various time points
See this image and copyright information in PMC

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