Comparison of Analgesic Efficacy of Erector Spinae Plane Block and Posterior Quadratus Lumborum Block in Laparoscopic Liver Resection: A Randomized Controlled Trial

RyungA Kang, Seungwon Lee, Gaab Soo Kim, Ji Seon Jeong, Mi Sook Gwak, Jong Man Kim, Gyu-Seong Choi, Yoon Jee Cho, Justin Sangwook Ko, RyungA Kang, Seungwon Lee, Gaab Soo Kim, Ji Seon Jeong, Mi Sook Gwak, Jong Man Kim, Gyu-Seong Choi, Yoon Jee Cho, Justin Sangwook Ko

Abstract

Purpose: Ultrasound-guided fascial plane blocks, including the erector spinae plane (ESP) and quadratus lumborum (QL) blocks, provide effective postoperative abdominal analgesia. However, there is limited evidence on the analgesic efficacy of ESP and QL blocks after liver surgery. Therefore, we aimed to compare the cumulative opioid consumption between the ESP and QL blocks in patients with hepatocellular carcinoma undergoing laparoscopic liver resection.

Patients and methods: Eighty-eight patients scheduled to undergo laparoscopic liver resection were randomized to receive bilateral single injection of ESP block at T8 (ESP group) or bilateral single injection of posterior QL block (QL group; 20 mL of 0.375% ropivacaine for each side, ie, total 150 mg of ropivacaine), in addition to intravenous (IV) fentanyl patient-controlled analgesia and multimodal analgesia. The primary outcome was cumulative opioid consumption over the first 24 h, expressed as IV morphine equivalents. Secondary outcomes included serial plasma ropivacaine concentrations, pain scores, time to first flatus, and Quality of Recovery-15 scores.

Results: Eighty-five patients were analyzed (ESP group, n = 42; QL group, n = 43). Cumulative 24-h opioid consumption was similar between the ESP and QL groups (41.4 ± 22.6 mg vs 44.2 ± 20.0 mg, mean difference (QL-ESP), 2.8 mg, 95% confidence interval, -6.4 to 12 mg, p > 0.99). There were no significant differences in resting pain scores at 24, 48 and 72 h postoperatively or recovery outcomes. The peak plasma ropivacaine concentration 30 min after injection was significantly higher in the ESP group (1.5 ± 0.3 µg/mL) than in the QL group (1.3 ± 0.5 µg/mL, p = 0.035); however, both were lower than the arterial threshold value of systemic toxicity (4.3 µg/mL).

Conclusion: ESP and QL blocks provided similar postoperative analgesia in patients undergoing laparoscopic liver resection.

Keywords: erector spinae plane block; laparoscopic liver resection; quadratus lumborum block; regional anesthesia; ropivacaine.

Conflict of interest statement

Prof. Dr. RyungA Kang report grants from Samsung Medical Center Grant # SMO1210471. The authors report no other conflicts of interest in this work.

© 2021 Kang et al.

Figures

Figure 1
Figure 1
Consolidated standards of reporting trials flow diagram showing patient progress through the study phases.
Figure 2
Figure 2
Numeric rating scale (NRS) scores at rest for the two groups within 72 hours postoperatively. P values result from a Bonferroni correction for multiple comparisons.
Figure 3
Figure 3
Chronological changes in total arterial plasma ropivacaine concentrations after blockade. P values result from a Bonferroni correction for multiple comparisons.

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