EFFICACY OF ULTRASOUND-GUIDED BILATERAL ERECTOR SPINAE PLANE BLOCK AS A COMPONENT OF MULTIMODAL ANALGESIA FOR POSTOPERATIVE PAIN CONTROL AFTER LAPAROSCOPIC CHOLECYSTECTOMY: A PROSPECTIVE COMPARATIVE OBSERVATIONAL STUDY AT A TERTIARY CARE HOSPITAL

Abstract

      The laparoscopic cholecystectomy (LC) remains the gold standard of surgical treatment for symptomatic cholelithiasis. However, it is associated with significant postoperative pain resulting in incisional, visceral and referred shoulder pain. In recent years, ESP-blocks have gained popularity as opioid-sparing analgesics because they spare the spine. During elective laparoscopic cholecystectomy, a prospective comparative observational study evaluating bilateral ultrasound guided ESP block at T7 level compared with MMA alone was conducted. A total of 100 adults were randomly assigned to two groups (50 per group): ESP block plus MMA (paracetamol plus NSAID + rescue tramadol, 0.25% ropivacaine) and control group alone (MMA). A non-random allocation process was used based on consent from patients and anaesthesiologist preference. Over the course of the day, opioid consumption (measured as tramadol equivalents) was the primary outcome. As secondary outcomes, we also assessed NRS pain scores at rest and when moving, time to first use of rescue analgesics, PONV, QoR-15 scores, length of stay, and ambulation time. Results: ESP block group lower ODE consumption by 78 mg over a 24 hour period in comparison to non-ESP group, which sees an increase of 154 mg. (p<0.001). 24 hours after resting, a NRS of 2.1 was observed compared to a NRS of 4.0 (p< 0.001). 7.4 2.8 versus 1.8 0.9 hours was significantly longer during the first rescue analgesic period (7.4 2.8 versus 1.8 0.9). PONV incidence decreased by 50% (16% versus 36%; p = 0.016). In the ESP group, there were higher QoR-15 ratings at 24 hours (130 vs 116; p< 0.001). There was a significant decrease in median LOS (1.8 vs 2.4 days; p 0.001). In the absence of LAST, no cases have been reported. According to multivariable regression analysis, the strongest independent predictor of decreased opioid usage was ESP block (p 0.001; β=−68 mg). An effective laparoscopic cholecystectomy technique that utilizes bilateral T7 ESP block in combination with a multimodal analytic approach can significantly decrease opioid consumption, postoperative pain, PONV, and length of stay after surgery. It appears feasible to implement ESP block routinely in resource-adequate settings for laparoscopic cholecystectomy.