Erector Spinae Plan Block for Postoperative Analgesia

Al Jedaani Hospital

Status: Completed

Conditions: Postoperative Pain

Treatments: Procedure: Erector Spinae Plan Block; Procedure: Oblique subcostal TAP

Study type: Interventional

Funder types: Other

Identifiers

NCT03398564

1/12

Details and patient eligibility

About

Laparoscopic cholecystectomy is a widely employed procedure in ambulatory surgery. Pain after laparoscopic cholecystectomy arises significantly from port site incisions in the anterior abdominal wall. Innervation of the anterior abdominal wall is segmentally supplied by pain afferents in the plane of fascia between transversus abdominis and the internal oblique muscles. Opioids analgesia is used to control postoperative pain, but it carries the risk of increased nausea and vomiting, ileus and sedation that may delay hospital discharge.

Several techniques have been tried as.neuroaxial narcotics, intraperitoneal lavage of local anesthetic and transversus abdominis plan (TAP) block and successfully reduced opioid use and improve postoperative analgesia.

The ultrasound-guided erector spinae plan(ESP) block is a recently described technique which produces reliable unilateral analgesia at thoraco-lumbar dermatomes. ESP block carries the advantages of being simple, safe, easily recognizable by ultrasound, and a catheter can be threaded to extend the duration of analgesia.

Few case series reported the efficacy of (US)-guided ESP blocks in reducing postoperative pain and opioids consumption.

Because of that, the investigators aimed to test the hypothesis that US-guided ESP blocks can decrease opioid consumption during the first 24 h after of laparoscopic cholecystectomy in comparison with the conventional systemic analgesia.

Enrollment: 70 patients

Sex: All

Ages: 20 to 60 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• 60 ASA I- II adult patients
• 20-60 years old
• elective laparoscopic cholecystectomy
• Body mass index (BMI) less than 35
• Port sites at or above thoracic T 10 dermatome

Exclusion criteria

• Allergy to amino-amide local anesthetics
• Presence of coagulopathy
• Local skin infection at the needle puncture sites
• Preoperative chronic dependence upon opioid and NSAID medications
• Liver or renal insufficiency
• History of psychiatric or neurological disease
• Deafness
• previous open surgery that need the conversion of laparoscopic to open surgery or manipulations more than expected with more tissue trauma
• American Society of Anesthesiologists (ASA) above Class II

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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70 participants in 3 patient groups, including a placebo group

Group I (Control)

Placebo Comparator group

Description:

ultrasound guided Bilateral Erector Spinae Plan Block using isotonic saline

Treatment:

Procedure: Erector Spinae Plan Block

Group II (ESP)

Active Comparator group

Description:

ultrasound guided Bilateral Erector Spinae Plan Block with bupivacaine 0.25%

Treatment:

Procedure: Erector Spinae Plan Block

Group III(OSTAP)

Active Comparator group

Description:

Ultrasound-guided bilateral oblique subcostal TAP block

Treatment:

Procedure: Oblique subcostal TAP