Comparison of Analgesic Efficacy of Erector Spinae and Oblique Subcostal Transverse Abdominis Plane Block in Laparoscopic Cholecystectomy

Abstract

Introduction: The pain after Laparoscopic Cholecystectomy (LC) which has both somatic and visceral component. Interfascial plane blocks play a major role in Multimodal Analgesia (MMA). Previous studies have found good analgesic benefits with Erector Spinae Plane (ESP) and Oblique Subcostal Transversus Abdominis Plane (OSTAP) blocks. However, till date no study exists which compares the above blocks with addition of dexamethasone. Aim: To compare ESP with OSTAP block using low concentration of Local Anaesthetic (LA) and dexamethasone as part of MMA in elective LC. Materials and Methods: A total of 66 patients were included in this study and finally, 60 patients were analysed. They were randomised to receive either bilateral ESP at T7 level or bilateral OSTAP with 20 mL 0.2% ropivacaine and 4 mg dexamethasone before starting anaesthesia. Primary outcome measures were total opioid consumption and mean Visual Analog Scale (VAS) in the first 24 hours postoperatively. Secondary outcome measures were intraoperative opioid consumption, opioids or block related complication, and patients’ feedback for procedural satisfaction and postoperative pain control. The results were analysed using the Statistical Package for the Social Sciences (SPSS) software version 23.0. Continuous and categorical data were analysed using appropriate statistical analysis. A p-value <0.05 was considered statistically significant. Results: Both the blocks provided excellent pain relief. The mean (24 hours) opioid consumption in ESP group was 29.83±54.74 mg and in OSTAP group was 73.17±94.04 mg; p=0.034. The mean VAS was significantly lower in the ESP block at all point of time during first 24 hours in ESP group was 0.58 and in OSTAP group was 1.72 (p<0.001). The mean intraoperative opioid requirement in ESP and OSTAP group were 6.9±1.8 mg and 7.6±2.3 mg of nalbuphine, respectively. No complications were noted in any patients. Conclusion: Addition of dexamethasone in ESP block provides significant analgesia and less opioid consumption in patients undergoing LC. Hence, ESP block can be considered as part of MMA in LC surgery.

A Comparative Evaluation of Post-operative Pain Management Using Erector Spinae Plane Block and Oblique Transverse Abdominis Plane Block in Patients Undergoing Laparoscopic Cholecystectomy

“…In the present study, feedback regarding post-operative pain relief was collected after the patient's discharge from the hospital. Similar to Sahu et al significantly more patients from the ESPB group were satisfied in comparison to the OSTAP group [13].…”

“…Sahu et al in their RCT compared the efficacy of ESPB and OSTAPB at T7 but did not find any significant difference in intraoperative opioid requirement between the groups, whereas there was a statistically significant difference in the mean VAS between the groups, which remained significantly lower in the ESP group during the first 24 hours as compared to OSTAPB. They concluded that ESPB was a superior block for laparoscopic cholecystectomy in comparison to OSTAPB [ 13 ]. In the present study, the patients in group O demanded tramadol significantly more times than those in group E, and the first analgesic demand was significantly delayed in group E (p < 0.001).…”

Analgesic effect of erector spinae plane block in adults undergoing laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials

“…Among them, five studies were excluded because of the pediatric population, two articles were excluded due to retrospective study, two for commentary, and one for conference abstract. Therefore, 15 RCTs involving 947 patients were included in this systematic review and meta-analysis [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36], and the detailed flow diagram is presented in Fig. 1.…”

Transversus Abdominis Plane Block as a Strategy for Effective Pain Management in Patients with Pain during Laparoscopic Cholecystectomy: A Systematic Review

“…However, the addition of a lesser amount of Dexamethasone 1 mcg to 0.5% Ropivacaine does not result in any significant change [ 88 ]. Again, the same concentration of 0.2% Ropivacaine with an additional 4 mg/kg Dexamethasone was used for different TAP block procedures, and the US-ESP group had less postoperative pain and required fewer opioids than the OSTAP block group [ 92 ]. The addition of 0.5 mg/kg Esmolol to the local anesthetic for TAP block infiltration is more effective for pain management than the addition of 0.9% normal saline [ 89 ].…”

“…The time to request rescue analgesia was higher in the US-BRILMA group (845) than in the US-TAP group (759.33) [ 93 ]. The efficacy of erector spinae block and oblique subcostal transversus abdominis block was compared, and the mean pain of the two groups between 2 and 24 h differed, with the OSTAP block group reporting more pain experience (2.27 to 0.70) [ 92 ]). The US-TAPB block group had significantly lower resting VAS values than the two groups receiving PCIA with Sufentanil and Nalbuphineat 2, 6, 12, 24, and 48 h postop ( p < 0.05) (Han et al, 2022).…”