To Evaluate The Postoperative Analgesic Effects Of A Bilateral Erector Spinae Plane Block Guided By Ultrasonography To Those Of Traditional Intravenous Opioids In Elective Laparoscopic Cholecystectomy- Comparative Study.

Abstract

Background- Postoperative analgesia in laparoscopic cholecystectomy has seen a recent uptick in popularity after the introduction of the Erector Spinae Plane Block. One main way that local anesthetics work is by physically spreading and diffusing to neuronal structures in the fascial plane, which in turn affects the erector spinae muscles and other tissue compartments. By using ultrasound, regional blocks may be performed more quickly, with fewer needle pricks, and with a shorter onset time.

Aims-“The purpose of this study is to evaluate the efficacy of standard intravenous opioids vs an ultrasound-guided bilateral erector spinae plane block in elective laparoscopic cholecystectomies for postoperative pain management.

Methods and material- This is a Randomized controlled trial done in Department of Anesthesiology, conducted at NKPSIMS and RC and LMC, Nagpur, a tertiary care center, Patients undergoing elective laparoscopic cholecystectomies under general anesthesia from November 2022 to May 2024. Total consecutive sample of 56 participants fulfilling eligibility criteria were selected by convenience sampling method.

Group B: ultrasound- guided bilateral erector spinae plane block, 20 cc of 0.375% ropivacaine, and 4 mg of dexamethasone on each side.” These patients did not receive IV injection Tramadol in Post-operative period.

Group O: Patients did not receive Erector Spinae Plane Block and surgery was allowed to start after administration of general anaesthesia. These patients were administered IV Tramadol 100mg 12 hourly in Post-operative period, first dose of which to be administered immediately after surgery.

Data was processed and analyzed using STATA version 10.1, 2011, a statistical program. Mean and standard deviation were used by descriptive statistics to describe quantitative factors, whereas frequency and percentage were employed to summarize qualitative variables. Two independent samples (unpaired) T test or Mann Whitney U test within each group at various time periods analyzed group differences in means of two groups, and inferential statistics included tests of significance and P values between the groups. Using Pearson's chi- square test, we compared the percentages of two sets of qualitative criteria. All comparisons were deemed statistically significant when the P value was less than 0.05.

Results- Most of the patients comes under 51-60 years of age. Group B: Ages 22-66 years, mean 44.96 years, SD 13.52 years. Group O: Ages 20-66 years, mean 42.54 years, SD 12.32 years. Group B: 42.86% males, 57.14% females. Group O: 39.29% males, 60.71% females. Patients are not statistically significant respected to height, weight and BMI. ASA Classification, Group B: 57.14% Grade I, 42.86% Grade II Group O: 53.57% Grade I, 46.43% Grade II. Duration of Pneumoperitoneum Group B: Range 1.25-3 hours, mean 2.05 hours, SD 0.43 hours Group O: Range 1.5-3 hours, mean 2.25 hours, SD 0.45 hours. Duration of Anesthesia Group B: Range 2-3.5 hours, mean 2.59 hours, SD 0.4 hours. Group O: Range 2-3.5 hours, mean 2.77 hours, SD 0.44 hours. There is no statistical significance respected to intraoperative hemodynamic events.  Numerical rating scale: At 2 hours [P value: 0.038 (significant difference)], At 4 hours: P value: <0.001(highly significant difference), At 6 hours: P value: <0.001(highly significant difference), At 12 hours: P value: <0.001(highly significant difference), At 24 hours: P value: 0.99(no significant difference). Time to first rescue analgesia: P value: <0.001(highly significant difference). Total Rescue Analgesia: P-value < 0.001 (highly significant difference). Respect to Side Effects: Nausea: P-value < 0.001 (highly significant difference), Vomiting: P-value: 0.009 (highly significant difference).

Conclusion- Group B significantly outperformed Group O in terms of intraoperative hemodynamic stability, and they needed less supplemental therapy and rescue analgesia overall. “There was a marked decrease in postoperative nausea and vomiting in Group B. The results of this study highlight the need of include ESP Blocks in the pain management plans of patients undergoing laparoscopic cholecystectomy procedures. When it comes to elective laparoscopic cholecystectomy, the ultrasound-guided bilateral erector spinae plane block seems to be a great way to improve perioperative outcomes, provide better hemodynamic stability, lessen the need for postoperative pain medication, and decrease the occurrence of postoperative complications.” This technique could potentially enhance patient comfort and satisfaction, leading to better overall surgical outcomes.