Skip to main content
SpringerLink
Log in

Erector spinae plane block reduces pain after laparoscopic cholecystectomy

Blockierung der Erector-spinae-Ebene reduziert Schmerzen nach laparoskopischer Cholezystektomie

  • Originalien
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Abstract

Purpose

After laparoscopic cholecystectomy patients have moderate pain in the early postoperative period. According to several studies an erector spinae plane (ESP) block can be a valuable part of multimodal analgesia. Our intention was to evaluate how ESP block influences postoperative pain scores and opioid consumption after laparoscopic cholecystectomy.

Methods

This single-blinded, prospective, randomized study included 60 patients undergoing laparoscopic cholecystectomy to receive either bilateral ESP block at the Th 7 level (n = 30) with 20 ml of 0.25% levobupivacaine plus dexamethasone 2 mg per side, or standard multimodal analgesia (n = 30). Patients from the standard multimodal analgesia group received tramadol 100 mg at the end of the procedure. Postoperative analgesia for both groups was acetaminophen 1 g/8 h i.v. and ketorolac 30 mg/8 h. Tramadol 1 mg/kg was a rescue treatment for pain breakthrough (numeric rating scale/NRS ≥ 6) in both groups. Pain at rest was recorded at 10 min, 30 min, 2 h, 4 h, 8 h, 12 h and 24 h after surgery using NRS (0–10).

Results

An ESP block significantly reduced postoperative pain scores compared to standard multimodal analgesia after 10 min (p = 0.011), 30 min (p = 0.004), 2 h (p = 0.011), 4 h (p = 0.003), 8 h (p = 0.013), 12 h (p = 0.004) and 24 h (p = 0.005). Tramadol consumption was significantly lower in the ESP group 25.02 ± 56.8g than in the standard analgesia group 208.3 ± 88.1g (p < 0.001).

Conclusion

An ESP block can provide superior postoperative analgesia and reduction in opioid requirement after laparoscopic cholecystectomy

Zusammenfassung

Ziel

Nach einer laparoskopischen Cholezystektomie haben Patienten in der frühen postoperativen Phase mäßige Schmerzen. Mehreren Studien zufolge kann der Erector-spinae-plane-Block (ESP) zum wertvollen Bestandteil der multimodalen Analgesie werden. Ziel dieser Arbeit war es, zu untersuchen, wie der ESP-Block den postoperativen Schmerzscore und den Opioidverbrauch nach einer laparoskopischen Cholezystektomie beeinflusst.

Methoden

Die einzelverblindete, prospektive, randomisierte Studie schloss 60 Patienten ein, die sich einer laparoskopischen Cholezystektomie unterzogen, um entweder einen bilateralen ESP-Block in Höhe des Th 7 (n = 30) mit 20 ml 0,25 % Levobupivacain plus Dexamethason 2 mg pro Seite oder eine standardmäßige multimodale Analgesie (n = 30) zu erhalten. Die Patienten der multimodalen Standardanalgesiegruppe erhielten am Ende des Eingriffs Tramadol 100 mg. Die postoperative Analgesie für beide Gruppen war Paracetamol 1 g/8 h i.v. und Ketorolac 30 mg/8 h. Tramadol 1 mg/kg war eine Rescue-Therapie bei Schmerzdurchbruch (NRS ≥ 6) in beiden Gruppen. Der Ruheschmerz wurde 10 min, 30 min, 2 h, 4 h, 8 h, 12 h und 24 h nach der Operation aufgezeichnet, wobei eine NR-Skala (0–10) verwendet wurde.

Ergebnisse

Der ESP-Block reduzierte deutlich die postoperativen Schmerzscores (NRS) im Vergleich zur multimodalen Standardanalgesie nach 10 min (p = 0,011), 30 min (p = 0,004), 2h (p = 0,011), 4h (p = 0,003), 8 h (p = 0,013), 12 h (p = 0,004) und 24 h (p = 0,005). Der Tramadolverbrauch war in der ESP-Gruppe mit 25,02 ± 56,8 g deutlich niedriger als in der Standardanalgesie-Gruppe mit 208,3 ± 88,1 g (p < 0,001).

Schlussfolgerung

Der ESP-Block kann eine überlegene postoperative Analgesie und eine Reduzierung des Opioidbedarfs nach laparoskopischer Cholezystektomie bieten

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Bisgaard T (2006) Analgesic treatment after laparoscopic cholecystectomy: a critical assessment of the evidence. Anesthesiology 104:835–846

    Article  Google Scholar 

  2. Barazanchi AWH, MacFater WS, Rahiri JI, Tutone S, Hill AG, Joshi GP (2018) Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update. Br J Anaesth 121(4):787–803

    Article  CAS  Google Scholar 

  3. Jesus RR, Leite AM, Leite SS, Vieira MC, Villela NR (2018) Anesthetic therapy for acute pain relief after laparoscopic cholecystectomy: systematic review. Rev Col Bras Cir 45(4):1885

    Article  Google Scholar 

  4. Sinha S, Munikrishnan V, Montgomery J, Mitchell SJ (2007) The impact of patient-controlled analgesia on laparoscopic cholecystectomy. Ann R Coll Surg Engl 89(4):374–378

    Article  CAS  Google Scholar 

  5. Lledó HB, Castro PB, Gavara IG, Cirión JLI, Andújar RL, Granero EG (2016) Twenty-five years of ambulatory laparoscopic. Cir Esp 94(8):429–441

    Article  Google Scholar 

  6. Zhao J, Peters L, Gelzinnis S, Carroll R, Nolan J, Di Sano S, Pockney P, Smith S (2020) Post-discharge opioid prescribing after laparoscopic appendicectomy and cholecystectomy. ANZ J Surg 90:1014–1018. https://doi.org/10.1111/ans.15882

    Article  PubMed  Google Scholar 

  7. Tolchard S, Davies R, Martindale S (2012) Efficacy of the subcostal transversus abdominis plane block in laparoscopic cholecystectomy: comparison with conventional port-site infiltration. J Anaesthesiol Clin Pharmacol 28:339–343

    Article  CAS  Google Scholar 

  8. Peng K, Ji FH, Liu HY, Wu SR (2016) Ultrasound-guided transversus abdominis plane block for analgesia in laparoscopic cholecystectomy: a systematic review and meta-analysis. Med Princ Pract 25:237–246

    Article  Google Scholar 

  9. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ (2016) The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 41(5):621–627

    Article  CAS  Google Scholar 

  10. Kot P, Rodriguez P, Granell M, Cano B, Rovira L, Morales J, Broseta A, Andrés J (2019) The erector spinae plane block: a narrative review. Korean J Anesthesiol 72(3):209–220

    Article  Google Scholar 

  11. Kadam VR, Wahba M (2018) Use of erector spinae plane block in open abdominal surgery and cancer pain. J Anaesthesiol Clin Pharmacol 34(4):564–567

    Article  Google Scholar 

  12. Hannig KE, Jessen C, Soni UK, Børglum J, Bendtsen TF (2018) Erector spinae plane block for elective laparoscopic cholecystectomy in the ambulatory surgical setting. Case Rep Anesthesiol 2018:5492527

    PubMed  PubMed Central  Google Scholar 

  13. Chin KJ, Malhas L, Perlas A (2017) The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery: a report of 3 cases. Reg Anesth Pain Med 42(3):372–376

    Article  Google Scholar 

  14. De Cassai A, Bonvicini D, Correale C, Sandei L, Tulgar S, Tonetti T (2019) Erector spinae plane block: a systematic qualitative review. Minerva Anestesiol 85(3):308–319

    Article  Google Scholar 

  15. Tulgar S, Kapakli MS, Senturk O, Selvi O, Serifsoy TE, Ozer Z (2018) Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a prospective, randomized, controlled clinical trial. J Clin Anesth 49:101–106

    Article  Google Scholar 

  16. Altiparmak B, Korkmaz Toker M, Uysal AI, Kuşçua Y, Gümüş Demirbilek S (2019) Efficacy of ultrasound-guided erector spinae planeblock for analgesia after laparoscopiccholecystectomy: a randomized controlled trial. Braz J Anesthesiol 69(6):561–568

    Article  Google Scholar 

  17. Tulgar S, Kapakli MS, Kose HC, Senturk O, Selvi O, Serifsoy TE et al (2019) Evaluation of ultrasound-guided erector spinae plane block and oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy: randomized, controlled, prospective study. Anesth Essays Res 13:50–56

    Article  Google Scholar 

  18. Altıparmak B, Korkmaz Toker M, Uysal AI, Kuşçu Y, Gümüş Demirbilek S (2019) Ultrasound-guided erector spinae plane block versus oblique subcostal transversus abdominis plane block for postoperative analgesia of adult patients undergoing laparoscopic cholecystectomy: Randomized, controlled trial. J Clin Anesth 57:31–36

    Article  Google Scholar 

  19. Niraj G, Zubair T (2018) Continuous erector spinae plane (ESP) analgesia in different open abdominal surgical procedures: a case series. J Anesth Surg 5(1):57–60

    Article  Google Scholar 

  20. Vrsajkov V, Mančić N, Mihajlović D, Milićević ST, Uvelin A, Vrsajkov JP (2018) Subcostal transversus abdominis plane block can improve analgesia after laparoscopic cholecystectomy. Rev Bras Anestesiol 68(2):149–153

    Article  Google Scholar 

  21. Loizides S, Gurusamy KS, Nagendran M, Rossi M, Guerrini GP, Davidson BR (2014) Wound infiltration with local anaesthetic agents for laparoscopic cholecystectomy. Cochrane Database Syst Rev 3:CD7049

    Google Scholar 

  22. Guo Q, Li R, Wang L, Zhang D, Ma Y (2015) Transversus abdominis plane block versus local anaesthetic wound infiltration for postoperative analgesia: a systematic review and meta-analysis. Int J Clin Exp Med 8(10):17343–17352

    PubMed  PubMed Central  Google Scholar 

  23. Kwon H, Kim D, Jeong S et al (2020) Does erector spinae plane block have a visceral analgesic effect?: A randomized controlled trial. Sci Rep 10:8389

    Article  CAS  Google Scholar 

  24. Bisgaard T, Rosenberg J, Kehlet H (2005) From acute to chronic pain after laparoscopic cholecystectomy: a prospective follow-up analysis. Scand J Gastroenterol 40(11):1358–1364

    Article  Google Scholar 

  25. Blichfeldt-Eckhardt MR, Ording H, Andersen C, Licht PB, Toft P (2014) Early visceral pain predicts chronic pain after laparoscopic cholecystectomy. Pain 155(11):2400–2407

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinical Centre of Vojvodina, Hajduk Veljkova 1-7, 21000, Novi Sad, Serbia

    Vladimir Vrsajkov, Nataša Ilić, Arsen Uvelin, Mirka Lukić-Šarkanović & Aleksandra Plećaš-Đurić

  2. Faculty of medicine, University of Novi Sad, Novi Sad, Serbia

    Arsen Uvelin

  3. Clinic of abdominal and endocrine surgery, Novi Sad, Serbia

    Radomir Ilić

Authors
  1. Vladimir Vrsajkov
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nataša Ilić
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arsen Uvelin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Radomir Ilić
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mirka Lukić-Šarkanović
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aleksandra Plećaš-Đurić
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vladimir Vrsajkov.

Ethics declarations

Conflict of interest

V. Vrsajkov, N. Ilić, A. Uvelin, R. Ilić, M. Lukić-Šarkanović and A. Plećaš-Đurić declare that they have no competing interests.

Ethical standards.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Additional information

figure qr

Scan QR code & read article online

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vrsajkov, V., Ilić, N., Uvelin, A. et al. Erector spinae plane block reduces pain after laparoscopic cholecystectomy. Anaesthesist 70 (Suppl 1), 48–52 (2021). https://doi.org/10.1007/s00101-021-01015-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-021-01015-5

Keywords

Schlüsselwörter

Search

Navigation