Ultrasound‐Guided Erector Spinae Plane Block in Patients Undergoing Laparoscopic Bariatric Surgery: A Prospective Randomized Controlled Trial

Abstract

Background Bariatric surgery is frequently complicated with considerable postoperative pain. We evaluated the impact of ultrasound‐guided erector spinae plane block on perioperative analgesia and pulmonary functions following laparoscopic bariatric surgery. Methods A total of 60 patients aged 18 to 65 years with a body mass index (BMI) of ≥ 40 kg/m2 were randomly allocated into two groups. Patients received either bilateral erector spinae plane block using 20 mL bupivacaine 0.25% at the level of the T7 transverse process or bilateral sham block using 20 mL normal saline on each side. Visual analog scale, intraoperative fentanyl consumption, the cumulative 24‐hour postoperative morphine consumption, and postoperative pulmonary functions were recorded. Results Visual analog scale for the first eight postoperative hours were significantly lower in the erector spinae plane block group than the control group. The median (interquartile range [IQR]) intraoperative fentanyl consumption was higher in the control group (159.5 [112.0 to 177.8] μg) than in the erector spinae plane block group (0.0 [0.0 to 74.5] μg) (P < 0.001). The median (IQR) cumulative 24‐hour postoperative morphine consumption was lower in the erector spinae plane block group (8.0 [7.0 to 9.0] mg) than in the control group (21.0 [17.0 to 26.25] mg) (P < 0.001, 95% CI [11.00, 15.00]). Postoperative pulmonary functions were significantly impaired in both groups compared with baseline values without significant difference between both groups. Conclusion Ultrasound‐guided erector spinae plane block provided satisfactory postoperative analgesia following laparoscopic bariatric surgery with decreased analgesic consumption without significant difference in postoperative pulmonary functions compared with the control group.

The Effect of Single-Shot Erector Spinae Plane Block (ESPB) on Opioid Consumption for Various Surgeries: A Meta-Analysis of Randomized Controlled Trials

“…Out of the 52 RCTs, 11 were about breast surgeries, 24–26 , 31 , 36 , 38 , 39 , 47 , 48 , 54 , 64 15 were about orthopedic surgeries, 10 , 11 , 21–23 , 27 , 28 , 32 , 33 , 50 , 52 , 53 , 56 , 57 , 60 5 were about thoracoscopic surgeries, 12 , 25 , 34 , 58 , 59 6 were about cholecystectomy, 29 , 30 , 41 , 45 , 63 , 65 6 were about nephrolithotomy, 37 , 44 , 49 , 61 , 62 , 68 2 were about cardiac surgeries, 14 , 42 and 7 were others. 40 , 43 , 46 , 51 , 55 , 66 , 67 The characteristics of enrolled 52 studies were listed in the Table 1 .…”

“… 40 , 43 , 46 , 51 , 55 , 66 , 67 The characteristics of enrolled 52 studies were listed in the Table 1 .…”

“…Totally, there were 19 studies researching nephrolithotomy (6 studies), 37 , 44 , 49 , 61 , 62 , 68 cholecystectomy (6 studies) 29 , 30 , 41 , 45 , 63 , 65 and other type of surgeries (7 studies). 40 , 43 , 46 , 51 , 55 , 66 , 67 By subgroup analyses, the findings were consistent with patients undergoing nephrolithotomy (MD: −13.29 mg; 95% CI: −19.59 to −6.99; p < 0.001; I 2 = 97%), cholecystectomy (MD: −4.80 mg; 95% CI: −6.16 to −3.45; p < 0.001; I 2 = 59%) and other types of surgery (−6.99 mg; 95% CI: −9.91 to −4.07; p < 0.001; I 2 = 92%) ( Figure 3 ).…”

“…Seventeen RCTs compared ESPB with a sham block (block with normal saline), 10 , 11 , 14 , 22 , 24 , 25 , 27 , 34 , 40 , 44–46 , 52 , 55 , 56 , 63 , 66 whereas 35 compared ESPB with no intervention. 12 , 21 , 23 , 26 , 28–33 , 35–39 , 41–43 , 47–51 , 53 , 54 , 57–62 , 64 , 65 , 67 , 68 Although subgroup analysis was conducted, no significant reduction of heterogeneity was detected ( Figure 4 ).…”

An analysis on the adjuvant efficacy of intravenous or perineural administered dexamethasone in erector spina plane block applied to patients who had thoracotomy: a prospective randomized double-blind study

“…The majority of ESPB research focuses on the analgesic effects in the first 24 hours after surgery (29)(30)(31)(32). In addition to the adjuvant effect of dexamethasone, its analgesic effect at 36 hours was evaluated in the present study.…”