Abstract
Aim & Objective: Laparoscopic cholecystectomy (LC) is a commonly performed minimally invasive surgery. LC can cause moderate to severe postoperative pain due to small keyhole entries on the abdominal wall. The oblique subcostal transversus abdominis plane block (OSTAP) has been used for postoperative analgesia after LC but found not so effective. Our aim is to compare the effectiveness of erector spinae block with OSTAP block for postop analgesia after LC. Materials and Methods: This prospective, randomized study was conducted at a tertiary care hospital. Seventy patients, 18 to 65 years old posted for LC were divided into two equal groups of 35 each. Erector spinae plane block was performed in the ESP group and oblique subcostal transverses abdominis plane block was performed in the OSTAP group. Postoperative rescue analgesic consumption, time to 1st rescue analgesia, numerical rating score (NRS), and any complications in 1st 24 hrs between the groups were compared. Results: Postoperative rescue analgesic (paracetamol) consumption was 1.9+ 0.85gm in ESP group and 2.84 + 0.29gm in OSTAP group which was statistically significant. Time to 1st rescue analgesia request was 360.34+28.94 mins in ESP group and 280.51+ 45.66 mins in OSTAP group which was statistically significant. Although NRS scores at almost all time-points were lower in the ESP group compared to OSTAP block, the difference was significant in 1st 6 hrs. Conclusion: Ultrasound guided ESP block reduced postoperative rescue analgesic consumption and pain scores more effectively than OSTAP block after laparoscopic cholecystectomy surgery. Keywords: Cholecystectomy, Laparoscopic, Pain management, Erector spinae plane block, Oblique subcostal transversus abdominis plane block.
Highlights
Laparoscopic cholecystectomy (LC) is the most common minimally invasive surgery in which intraoperative access is provided with small keyhole entries on abdominal wall
Multimodal approaches with nonsteroidal anti-inflammatory drugs, dexamethasone, gabapentinoids, opioids, local anesthetic infiltration to port sites, epidural analgesia and transversus abdominis plane block (TAP) have been used to attenuate postoperative pain caused after LC. 2 Hebbard et al 3 described the subcostal approach of TAP block for postoperative analgesia for upper abdominal surgeries
Few studies have reported that ESP block provided analgesia after different abdominal, thoracic, breast and spinal surgeries. 7,8 The present study was aimed to evaluate the analgesic efficacies of ultrasound-guided ESP block and oblique subcostal abdominis plane (OSTAP) block after laparoscopic cholecystectomy surgeries
Summary
Laparoscopic cholecystectomy (LC) is the most common minimally invasive surgery in which intraoperative access is provided with small keyhole entries on abdominal wall. LC causes moderate to severe postoperative pain which has different components; incisional pain from the trocar site (somatic pain),and local visceral pain (deep abdominal pain). Multimodal approaches with nonsteroidal anti-inflammatory drugs, dexamethasone, gabapentinoids, opioids, local anesthetic infiltration to port sites, epidural analgesia and transversus abdominis plane block (TAP) have been used to attenuate postoperative pain caused after LC. Many studies have reported that ultrasound guided oblique subcostal abdominis plane (OSTAP) blocks reduced postoperative pain scores and opioid consumption in the first 24 hrs after LC. Forero et al 6 described the ultrasound guided ESP block which is a novel technique targeting the ventral rami, dorsal rami, and rami communicantes of the spinal nerves there by effective against both somatic and visceral pain. Few studies have reported that ESP block provided analgesia after different abdominal, thoracic, breast and spinal surgeries. The secondary endpoints were time of 1st rescue analgesia request, comparisons of NRS score at different time points, and complications in 1st 24 hrs
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