Journal of Pain Research (Sep 2022)

Ultrasound Guided Continuous Erector Spinae Plane Block versus Patient Controlled Analgesia in Open Nephrectomy for Renal Malignancies: A Randomized Controlled Study

  • Abdelgalil AS,
  • Ahmed AM,
  • Gamal RM,
  • Elshal MM,
  • Bakeer AH,
  • Shaker EH

Journal volume & issue
Vol. Volume 15
pp. 3093 – 3102

Abstract

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Ahmed Salah Abdelgalil, Ahmed Mansour Ahmed, Reham M Gamal, Mamdouh Mahmoud Elshal, Ahmed Hussein Bakeer, Ehab Hanafy Shaker Anesthesia, Intensive Care and Pain Management, National Cancer Institute, Cairo University, Cairo, EgyptCorrespondence: Ahmed Salah Abdelgalil, Anesthesia, Intensive Care and Pain Management, National Cancer Institute, Cairo University, Cairo, 11796, Egypt, Email [email protected]: It is critical to manage acute postoperative pain for patient satisfaction and better outcome. Erector spinae plane block (ESPB) can produce sensory blocking on both visceral and somatic levels. This study aimed to evaluate the ESPB efficacy in controlling acute postoperative pain in open nephrectomy for renal malignancies.Methods: This prospective randomized, controlled, open-label trial included 60 cases scheduled for open nephrectomy for renal malignancy under general anesthesia. Cases were assigned randomly into two equal groups. Group E administered continuous preoperative unilateral ESPB (20mL bupivacaine 0.25% bolus then 6 mL/h 0.1% for 48 hours). Group C administered intravenous (IV) patient-controlled analgesia (PCA) morphine (0.01 mg/kg/h). Postoperative analgesia was managed by morphine (3 mg IV in group E or 0.01 mg/kg bolus with a 15-min lockout in group C) to keep the visual analog scale (VAS) scores < 4.Results: Intraoperative fentanyl consumption and total morphine consumption in 1st 48 hours postoperatively were significantly lower in group E than group C (P= 0.001 and < 0.001, respectively). The time to first analgesic request was significantly longer in group E than group C (P < 0.001). VAS scores at movement and rest were significantly lower in group E than group C (P < 0.001).Conclusion: In renal malignancies, ESPB provided better analgesia with prolonged time and lower pain scores at both rest and movement compared to IV PCA following open nephrectomy.Keywords: erector spinae plane block, PCA, analgesia, nephrectomy, renal malignancy

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