Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.04.020
Brazilian Journal of Anesthesiology
Original Investigation

Bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled study

Bloqueio do plano eretor da espinha bilateral versus unilateral para analgesia pós-operatória em colecistectomia laparoscópica: um estudo controlado randomizado

Sevim Cesur, Hadi Ufuk Yörükoğlu, Can Aksu, Alparslan Kuş

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Abstract

Introduction
Laparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al. the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations.

Methods
This study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologistas (ASA) physical status I-II, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups.

Results
There was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6th hour (p =  0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p =  0.044 and p =  0.022 respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p =  0.011).

Conclusion
In conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.

Keywords

Nerve Block,  Ultrasound Imaging,  Erector Spinae Plane Block,  Laparoscopic Cholecystectomy,  Analgesia

Resumo

Introdução

A colecistectomia laparoscópica (CL) é a intervenção cirúrgica comum para doenças biliares benignas. A dor pós-operatória após CL permanece como um problema importante, com dois componentes: somático e visceral. As incisões de entrada do trocater levam à dor somática, enquanto a distensão peritoneal com irritação do diafragma leva à dor visceral. Seguindo sua descrição por Forero et al. o bloqueio do plano eretor da espinha (PEE) adquiriu considerável popularidade entre os clínicos. Isso levou ao uso do bloqueio PEE para controle da dor pós-operatória em várias operações.

Métodos

Este estudo foi realizado entre janeiro e junho de 2019. Foram incluídos no estudo pacientes com idade entre 18 e 65 anos, estado físico I-II da American Society of Anesthesiologistas (ASA), agendados para colecistectomia laparoscópica eletiva. Todos os pacientes receberam bloqueio PEE bilateral ou unilateral no nível T8 no pré-operatório de acordo com seus grupos.

Resultados

Não houve diferença significativa entre os grupos em termos de escores NRS em repouso ou durante a tosse em qualquer intervalo de tempo, exceto na 6ª hora pós-operatória (p =  0,023). O consumo de morfina foi semelhante entre os grupos, mas foi significativamente menor no grupo B em 12 e 24 horas (p =  0,044 e p =  0,022, respectivamente). Doze pacientes do grupo A e três pacientes do grupo B apresentaram dor no ombro e essa diferença foi estatisticamente significativa (p =  0,011).

Conclusão

Em conclusão, o bloqueio PEE bilateral proporcionou analgesia mais eficaz do que o bloqueio PEE unilateral em pacientes submetidos a CL eletiva. O bloqueio PEE bilateral reduziu a quantidade de consumo de opioides e a incidência de dor pós-operatória no ombro.

Palavras-chave

Bloqueio de Nervos; Ultrassom; Bloco do Plano Eretor da Espinha; Colecistectomia Laparoscópica; Analgesia

References

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