Effects of Erector Spina Plan Block and Epidural Analgesia in Whipple Surgery


Ankara City Hospital




Pancreatic Cancer

Study type


Funder types




Details and patient eligibility


Pancreatic surgery is generally a high-risk and difficult to manage perioperatively. surgery. In pancreatic surgery, in addition to general anaesthesia, central blocks for analgesia and peripheral blocks are also preferred. In this study, in patients undergoing whipple surgery epidural and erector spina plan block (ESP) may cause intraoperative and postoperative pain, renal functions and haemodynamic variables.

Full description

Pancreatic surgery and anaesthetic management is a difficult operation due to the anatomical location and function of the pancreas. Thoracic epidural anaesthesia/analgesia (TEA) in addition to general anaesthesia in upper abdominal surgeries such as pancreas, liver and stomach.Thoracic epidural analgesia (TEA) is the most widely used gold standard in this type of surgery. TEA may cause haemodynamic changes in patients due to decreased sympathetic tone due to sympathetic nerve blockade. In elderly patients, bradycardia and hypotension is observed more frequently. Cardiovascular response decreases with age due to decreased cardiac reserve and deterioration of the autonomic nervous system and arteriolar structure. This can lead to this is because more segments are blocked than in younger patients. Pain control with thoracic epidural will provide pulmonary rehabilitation and rapid mobilisation. Accordingly, thromboembolic events, atelectasis and pulmonary infections are prevented. However, it has important unwanted side effects such as hypotension, dural puncture and contralateral block. All these disadvantages of TEA has increased interest in alternatives. Peripheral regional anaesthesia techniques have become more popular as a component of multimodal analgesia to avoid complications associated with epidural analgesia. In 2016, ESP block, which is an ultrasound-controlled fascial plane block, was described. ESP block is considered to be an easier, effective and safer alternative to epidural and paravertebral blocks. The mechanism of action of ESP involves blockade of both dorsal and ventral branches, resulting in somatic and visceral analgesia. Intraoperative and postoperative renal function may be impaired in upper abdominal surgeries. Acute kidney injury (AKI) is an important cause of postoperative mortality and morbidity. The most serious adverse factor is both surgical and anaesthesia-related AKI. hypotension that may develop. The duties of the anaesthesiologist include maintaining perioperative renal function, predetermining the risk of AKI and taking necessary precautions. Considering the data in the literature, postoperative AKI Recent studies have shown that there is a link between inflammation and cancer. Studies reveal a relationship between cytokine and chemokine production and tumour growth, angiogenesis and metastatic capacity. Inflammatory cells and substances produced by inflammation affect cells in the peripheral blood. Platelets promote extravasation of circulating tumour cells. Neutrophils can also promote tumour adhesion and seeding by secreting growth factors into the peripheral circulation. However, lymphocytes can exert anti-tumour effects by inhibiting the proliferation and migration of tumour cells. From this point of view, SII (Systemic inflammation index) is a new prognostic factor obtained by measuring the number and ratio of neutrophils, platelets and lymphocytes in the peripheral blood of many tumours. In this study, the effects of epidural analgesia and ESP block on intraoperative opioid requirement and postoperative pain scores, as well as perioperative renal parameters, haemodynamic data and SII (Systemic inflammation index) were investigated and the alternative of ESP block to epidural analgesia was investigated.


65 patients




18 to 80 years old


Accepts Healthy Volunteers

Inclusion criteria

  • Patients undergoing whipple surgery,
  • ASA (The American Society of Anesthesiologists) I-III risk grup
  • Between the ages of 18-80

Exclusion criteria

  • Those who do not accept the transaction,
  • Serious cardiovascular disease,
  • Those for whom epidural anesthesia and peripheral blocks are contraindicated,
  • Those who have had spinal surgery,
  • Those who are allergic to one of the local anesthetics to be used,
  • Those whose hemoglobin value is below 10 g/dl) disease,
  • Those with drug and alcohol addiction,

Trial design

65 participants in 2 patient groups

Epidural analgesia
The patients were fasted for 8 hours before the operation without premedication. The patient was taken to the operation room. In all cases, a vein on the back of the hand was cannulated for peripheral venous catheter was cannulated from the back of the hand. Standard monitoring was applied. In the epidural group, 42 patients received a standard 18 G injection at the appropriate level between T8 and T10. The epidural space was entered by loss of resistance method with touchy needle. 15 µg in 3 mL saline The test dose was administered by administering epinephrine. Then the epidural catheter was inserted towards the cranium. was advanced five cm. Bupivacaine 0.25% was started as infusion through the catheter. Since the mean arterial pressure dropped below 60 mm/hg in 5 patients, epidural infusion was stopped and inotropic treatment was started.
Erector Spina Plan(ESP) Block
Esp group included 28 patients in the preoperative operating theatre between T8 and T10 1 hour before the operation. level, the USG (ultrasonography) probe is placed in the midline in the cephalocaudal direction and then the USG (ultrasonography) probe is placed approximately 3 cm laterally over the transverse processes and transverse with the erector spinae muscle 0.25 % bupivacaine 20 cc each in the fascial plane between the processes bilateral thoracic erector spina block and then 50 mg dexketoprofen before surgery implemented.

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Data sourced from clinicaltrials.gov

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