Comparative Study between Bilateral and Unilateral Erector Spinae Plane Block in Managing Postoperative Pain in Laparoscopic Cholecystectomy
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Abstract
Background: Postoperative pain after laparoscopic cholecystectomy remains as an important problem, with two components: somatic and visceral. Surgical incisions lead to somatic pain, while abdominal inflation and diaphragm irritation leads to visceral pain. Erector spinae plane block is a newly described interfascial plane block.
Aim: to compare bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy
Patients and Methods: The study involved 50 patients scheduled for elective laparoscopic cholecystectomy. Patients were randomly assigned in to two equal groups each with 25 patients: unilateral and bilateral erector spinae plane block. Numerical Pain score and need for analgesia during all time points to 12 hr post recovery; hemodynamic indices at baseline, during all time poins from full recovery to 12 hr post recovery were recored.
Results: there were no significant differences between the two groups in hemodynamic indices. At 12thhr post operation, 36%, 12% and 36% of patients in unilateral group demonstrated mild, moderate and required rescue analgesia, respectively compared with 28%, 8% and 20% of patients in bilateral group with a statistically significant difference. at 3rdhr post operation, 12% and 8% of patients in unilateral group need paracetamol and tramal, respectively, compared 4% and 0%, respectively in bilateral group, with a significant difference. Additionally, at 12thhr post operation, 34% and 12% of patients in unilateral group need paracetamol and tramal, respectively, compared 28% and 8%, respectively in bilateral group, with a significant difference.
Conclusions: Unilateral and bilateral erector spinae plane block seem to have no serious impact hemodynamic indices. Bilateral block is associated with lower pain score and need for postoperative analgesia than unilateral block
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