Influence of ultrasound-guided erector spinae plane block on post-operative pain and diaphragmatic dysfunction in obese patients undergoing repair of Epigastric Hernia

Abstract

ABSTRACTBackground Repair of ventral hernia is associated with pain after operation. We wanted to study the influence of ultrasound-guided (US) erector spine plane (ESP) block on postoperative pain and diaphragmatic dysfunction in obese cases undergoing repair of epigastric hernia.Methods This prospective randomized-controlled double-blinded research was conducted on 50 obese cases with body mass index (30–40), aged (21–65) and scheduled for elective open repair of epigastric hernia. Cases were randomized into two equal groups to receive either general anesthesia alone (Controls) or general anesthesia combined with bilateral ultrasound-guided ESP block. Postoperative pain, 24 h postoperative analgesic dose, and postoperative diaphragmatic excursion were assessed.Results There was a statistically evident decrease in NRS score in the ESP versus controls (30 min, 2 hr, 6 hr, 12 hr)(p < 0.001). There was a statistically evident decrease in the total intraoperative fentanyl (p < 0.001) and total 24 h morphine dose (p < 0.001) in the ESP versus controls. There was a statistically evident decrease in the postoperative diaphragmatic excursion in controls versus the ESP (p = 0.001).Conclusions The ESP block in obese cases undergoing open repair of epigastric hernia provided efficient postoperative analgesia. It decreased postoperative pain, reduced intraoperative and postoperative analgesic dose, and maintained diaphragmatic excursion.

Keywords

• Post-operative pain
• ultrasound guided
• obese cases
• erector spine plane block
• diaphragmatic dysfunction
• repair of epigastric hernia