A novel comparison of erector spinae plane block and paravertebral block in laparoscopic cholecystectomy

Abstract

Objective: Erector spinae plane block is an updated method than paravertebral block, possessing a lower risk of complications. This study aimed to compare erector spinae plane and paravertebral blocks to safely reach the most efficacious analgesia procedure in laparoscopic cholecystectomy cases.

Methods: The study included 90 cases, aged 18-70 years, classified as American Society of Anesthesiologists I-II, who underwent an laparoscopic cholecystectomy procedure. They were randomly separated into three groups, namely, Control, erector spinae plane, and paravertebral block. No block procedure was applied to Control, and a patient-controlled analgesia device was prepared containing tramadol at a 10 mg bolus dose and a 10-min locked period. The pain scores were recorded with a visual analog scale for 24 h postoperatively.

Results: The visual analog scale values at 1, 5, 10, 20, and 60 min at rest and 60 min coughing were found to be significantly higher in Control than in paravertebral block. A significant difference was revealed between Control vs. paravertebral block and paravertebral block vs. erector spinae plane in terms of total tramadol consumption (p=0.006). Total tramadol consumption in the first postoperative 24 h was significantly reduced in the paravertebral block compared with the Control and erector spinae plane groups.

Conclusion: Sonography-guided-paravertebral block provides sufficient postoperative analgesia in laparoscopic cholecystectomy surgery. Erector spinae plane seems to attenuate total tramadol consumption.

Figure 1. Consolidated standards of reporting trials flow diagram.

Figure 2. (A) A sonographic imaging of thoracal paravertebral block (the arrow indicates the location of the needle, placed craniocaudally within the fascial plane of the deep surface of the erector spinae muscle above the bone shadow of the transverse process). (B) A sonographic imaging of erector spinae block (the arrow indicates the location of the needle, placed in the paravertebral space above the pleura). PVP: paravertebral block; ESP: erector spinae block.