Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.02.014
Brazilian Journal of Anesthesiology
Scientific Article

Comparison between erector spinal plane block and epidural block techniques for postoperative analgesia in open cholecystectomies: a randomized clinical trial

Comparação entre as técnicas de bloqueio do plano do músculo eretor da espinha e bloqueio epidural para analgesia pós-operatória em colecistectomias abertas: um ensaio clínico randomizado

Thiago Mamoru Sakae, Luiz Henrique Ide Yamauchi, Augusto Key Karazawa Takaschima, Julio C Brandão, Roberto Henrique Benedetti

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Abstract

Introduction and objectives
Blockade of the Erector Spinal Muscle (ESP Block) is a relatively new block, initially described for chronic thoracic pain analgesia, but it has already been described for anesthesia and analgesia in thoracic surgical procedures and, more recently, for high abdominal surgeries. The aim of the study was to compare two techniques, ESP Block and Epidural Block with morphine and local anesthetic for postoperative analgesia of open cholecystectomy surgeries.

Methods
Controlled single-blind randomized clinical trial with 31 patients (ESP Block, n = 15; Epidural, n = 16), of both genders, ages between 27 and 77 years. The ESP block was performed at the T8 level with injection of 20 mL of 0.5% ropivacaine bilaterally. The epidural block was performed at the T8‒T9 space with 20 mL of 0.5% ropivacaine and 1 mg of morphine.

Results
The ESP Block group presented higher mean ​​Numeric Pain Scale (NPS) values for pain in the up to 2 hour (p =  0.001) and in the 24 hour (p =  0.001) assessments. The ESP Block group had a three-fold increased risk (43.7% vs. 13.3%) of rescue opioid use in the 24 postoperative hours when compared to the epidural group (RR = 3.72, 95% CI: 0.91 to 15.31, p =  0.046).

Conclusion
ESP Block did not prove to be an effective technique for postoperative analgesia of open cholecystectomy, at the doses performed in this study, having required more use of rescue opioid, and without differences in NPS. More comprehensive studies are required to assess the efficacy of ESP block for the visceral and abdominal somatic component, considering the specific blockade level.

Keywords

Cholecystectomy;  Analgesia;  Regional anesthesia;  Randomized controlled trial

Resumo

Justificativa e objetivo
O Bloqueio do Plano do Músculo Eretor da Espinha (ESP Block) é um bloqueio relativamente novo, inicialmente descrito para analgesia de dor torácica crônica, porém já descrito para anestesia e analgesia em procedimentos cirúrgicos torácicos e, mais recentemente, para cirurgias abdominais altas. O estudo objetivou comparar as técnicas de bloqueio ESP Block e bloqueio Epidural com morfina e anestésico local para analgesia pós-operatória de cirurgias de colecistectomia aberta.

Método
Estudo clínico randomizado controlado, unicego com 31 pacientes (ESP Block, n = 15; Epidural, n = 16), de ambos os sexos, idades entre 27 e 77 anos. O ESP Block foi realizado no nível de T8 com injeção de 20 mL de ropivacaína 0,5% bilateral. O bloqueio Epidural foi realizado no espaço T8‒T9 com 20 mL de ropivacaína 0,5% e 1 mg de morfina.

Resultados
O grupo ESP Block apresentou valores médios de dor pela Escala Visual Numérica (EVN) maiores nas avaliações até 2 horas (p =  0,001) e em 24 horas (p =  0,001). O grupo ESP Block apresentou um risco três vezes maior – 43,7% vs. 13,3% – de uso de opioide de resgate em 24 horas pós-operatórias do que o grupo epidural (RR = 3,72; 95% IC 0,91 a 15,31; p =  0,046).

Conclusão
Nas doses realizadas nesse estudo, o ESP Block não se mostrou uma técnica efetiva para analgesia pós-operatória de colecistectomia aberta, com mais uso de opioide de resgate e sem diferenças na escala visual numérica de dor. Necessita-se de estudos mais abrangentes avaliando a eficácia do ESP block para o componente visceral e somático abdominal, considerando o nível do bloqueio específico.

Palavras-chave

Colecistectomia;  Analgesia;  Anestesia regional;  Ensaio controlado randomizado

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