Evaluation of Ultrasound-Guided Erector Spinae Plane Block and Oblique Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy: Randomized, Controlled, Prospective Study

Serkan Tulgar, Mahmut Sertan Kapakli, Halil Cihan Kose, Ozgur Senturk, Onur Selvi, Talat Ercan Serifsoy, David Terence Thomas, Zeliha Ozer, Serkan Tulgar, Mahmut Sertan Kapakli, Halil Cihan Kose, Ozgur Senturk, Onur Selvi, Talat Ercan Serifsoy, David Terence Thomas, Zeliha Ozer

Abstract

Background: Oblique subcostal transversus abdominis plane block (OSTAP) is a recently described regional anesthetic technique used in upper abdominal surgeries such as laparoscopic cholecystectomy (LC). Erector spinae plane block (ESPB) has also been reported for postoperative analgesia in LC.

Aim: We aimed to compare the effectiveness of OSTAP and ESPB in providing postoperative analgesia in patients undergoing these surgeries.

Setting and design: This study was designed as a double-blinded, prospective, randomized, efficiency study in a tertiary university hospital, postoperative recovery room, and ward.

Materials and methods: A total of 72 patients were recruited and 60 patients were randomized into three equal groups (ESPB, OSTAP, and control group). Pain intensity between groups was compared using Numeric Rating Scale (NRS) scores. In addition, consumption of paracetamol and tramadol and additional rescue analgesic requirement were measured. Standard multimodal analgesia was performed in all groups, while ESPB block was also performed in Group ESPB and OSTAP block was also performed in group OSTAP.

Statistical analysis used: Descriptive statistics were expressed as mean ± standard deviation. Independent t-test, Mann-Whitney U-test, Chi-square test, Fisher's exact test, Shapiro-Wilk test, one-way ANOVA, and post hoc Tukey's analysis were used for statistical analysis.

Results: NRS was lower in block groups during the first 3 h. There was no difference in NRS scores at other hours. Analgesic consumption and rescue analgesic requirement were lower in groups ESPB and OSTAP when compared to those of control group. Block groups were similar.

Conclusion: Bilateral ultrasound-guided ESPB and OSTAP performed at the end of LC lead to akin analgesia requirement and improve the quality of multimodal analgesia.

Keywords: Cholecystectomy laparoscopic; nerve blocks; pain management.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Consort diagram of the study
Figure 2
Figure 2
Probe position and sonoanatomic view of erector spinae plane block performed at T8–T9 transverse process. ESM = Erector spinae muscle, TP = Transverse process, Yellow point (*) is injection point
Figure 3
Figure 3
Probe position and sonoanatomic view of oblique subcostal transversus abdominis plane block performed at interfascial plane between transverse abdominis muscle and rectus abdominis muscle. Yellow points (*) are injection points
Figure 4
Figure 4
Average Numeric Rating Score scores at rest, for groups erector spinae plane block, oblique subcostal transversus abdominis plane block, and control at various time points of follow-up
Figure 5
Figure 5
Average Numeric Rating Score scores during coughing/movement, for Groups erector spinae plane block, oblique subcostal transversus abdominis plane, block and control at various time points of follow-up

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