[Comparison between erector spinal plane block and epidural block techniques for postoperative analgesia in open cholecystectomies: a randomized clinical trial].

Abstract

INTRODUCTION AND OBJECTIVES:

Blockade of the Erector Spinal Muscle (ESP block) is a relatively new block, initially described for chronic thoracic pain analgesia, but it has already been described for anesthesia and analgesia in thoracic surgical procedures and, more recently, for high abdominal surgeries. The aim of the study was to compare two techniques, ESP Block and Epidural block with morphine and local anesthetic for postoperative analgesia of open cholecystectomy surgeries.

METHODS:

Controlled single-blind randomized clinical trial with 31 patients (ESP block, n = 15; Epidural, n = 16), of both genders, ages between 27 and 77 years. The ESP block was performed at the T8 level with injection of 20 mL of 0.5% ropivacaine bilaterally. The epidural block was performed at the T8-T9 space with 20 mL of 0.5% ropivacaine and 1 mg of morphine.

RESULTS:

The ESP block group presented higher mean Numeric Pain Scale (NPS) values for pain in the up to 2 hour (p = 0.001) and in the 24 hour (p = 0.001) assessments. The ESP block group had a three-fold increased risk (43.7% vs. 13.3%) of rescue opioid use in the 24 postoperative hours when compared to the epidural group (RR = 3.72, 95% CI: 0.91 to 15.31, p = 0.046).

CONCLUSION:

ESP block did not prove to be an effective technique for postoperative analgesia of open cholecystectomy, at the doses performed in this study, having required more use of rescue opioid, and without differences in NPS. More comprehensive studies are required to assess the efficacy of ESP block for the visceral and abdominal somatic component, considering the specific blockade level.

• Authors: Thiago Mamoru Sakae, Luiz Henrique Ide Yamauchi, Augusto Key Karazawa Takaschima, Julio C Brandão, Roberto Henrique Benedetti
• Journal: Brazilian journal of anesthesiology (Elsevier) (Braz J Anesthesiol) 2020 Jan - Feb Vol. 70 Issue 1 Pg. 22-27 ISSN: 2352-2291 [Electronic] Brazil
• Vernacular Title: Comparação entre as técnicas de bloqueio do plano do músculo eretor da espinha e bloqueio epidural para analgesia pós‐operatória em colecistectomias abertas: um ensaio clínico randomizado.
• PMID: 32171499 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2020. Publicado por Elsevier Editora Ltda.

Topics

• Adult
• Aged
• Analgesia (methods)
• Analgesia, Epidural
• Back Muscles (innervation)
• Cholecystectomy (methods)
• Female
• Humans
• Male
• Middle Aged
• Nerve Block (methods)
• Pain, Postoperative (therapy)
• Single-Blind Method