Comparison of Analgesic Efficacy of Erector Spinae and Oblique Subcostal Transverse Abdominis Plane Block in Laparoscopic Cholecystectomy
Introduction: The pain after Laparoscopic Cholecystectomy (LC) which has both somatic and visceral component. Interfascial plane blocks play a major role in Multimodal Analgesia (MMA). Previous studies have found good analgesic benefits with Erector Spinae Plane (ESP) and Oblique Subcostal Trans...
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| Autores principales: | , , , , , |
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| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
JCDR Research and Publications Private Limited
2021
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| Materias: | |
| Acceso en línea: | https://doaj.org/article/cbb8764c755e415796a4b21171c9be8d |
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| Sumario: | Introduction: The pain after Laparoscopic Cholecystectomy (LC)
which has both somatic and visceral component. Interfascial plane
blocks play a major role in Multimodal Analgesia (MMA). Previous
studies have found good analgesic benefits with Erector Spinae
Plane (ESP) and Oblique Subcostal Transversus Abdominis
Plane (OSTAP) blocks. However, till date no study exists which
compares the above blocks with addition of dexamethasone.
Aim: To compare ESP with OSTAP block using low concentration
of Local Anaesthetic (LA) and dexamethasone as part of MMA
in elective LC.
Materials and Methods: A total of 66 patients were included
in this study and finally, 60 patients were analysed. They were
randomised to receive either bilateral ESP at T7 level or bilateral
OSTAP with 20 mL 0.2% ropivacaine and 4 mg dexamethasone
before starting anaesthesia. Primary outcome measures were
total opioid consumption and mean Visual Analog Scale (VAS) in
the first 24 hours postoperatively. Secondary outcome measures
were intraoperative opioid consumption, opioids or block related
complication, and patients’ feedback for procedural satisfaction
and postoperative pain control. The results were analysed using
the Statistical Package for the Social Sciences (SPSS) software
version 23.0. Continuous and categorical data were analysed
using appropriate statistical analysis. A p-value <0.05 was
considered statistically significant.
Results: Both the blocks provided excellent pain relief. The mean
(24 hours) opioid consumption in ESP group was 29.83±54.74 mg
and in OSTAP group was 73.17±94.04 mg; p=0.034. The mean
VAS was significantly lower in the ESP block at all point of time
during first 24 hours in ESP group was 0.58 and in OSTAP group
was 1.72 (p<0.001). The mean intraoperative opioid requirement
in ESP and OSTAP group were 6.9±1.8 mg and 7.6±2.3 mg of
nalbuphine, respectively. No complications were noted in any
patients.
Conclusion: Addition of dexamethasone in ESP block provides
significant analgesia and less opioid consumption in patients
undergoing LC. Hence, ESP block can be considered as part of
MMA in LC surgery |
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