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

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.