Comparison of Postoperative Analgesic Effects of Bilateral Erector Spinae Plane Block Guided by Ultrasonography with Traditional Intravenous Opioids in Elective Laparoscopic Cholecystectomy: A Randomized Controlled Study

Background: Spinal anesthesia is associated with intraoperative hypotension so it is unsuitable for hemodynamically unstable patients. Intraoperative gas insufflation, artificial pneumoperitoneum compression and diaphragmatic displacement increase intrathoracic pressure and reduce preload. 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.

Materials and Methods: This is a Randomized controlled trial done in the 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. A total consecutive sample of 56 participants fulfilling eligibility criteria was selected by convenience sampling method. Using Pearson's chi-square test, the percentages of two sets of qualitative criteria were compared. All comparisons were deemed statistically significant when the P value was less than 0.05.

Results: Most of the patients come 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 with respect 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. Significant differences in intraoperative hemodynamic events, additional treatment requirements, rescue analgesia, and side effects underscore the importance of advanced analgesic techniques in improving patient outcomes. These comparative insights provide valuable context for our results and suggest avenues for future research and clinical practice improvements.

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 to 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. The technique could potentially enhance patient comfort and satisfaction, leading to better overall surgical outcomes.