Comparison of Analgesic Efficacy of Erector Spinae and Oblique Subcostal Transverse Abdominis Plane Block in Laparoscopic Cholecystectomy

Abstract

Introduction: The pain after Laparoscopic Cholecystectomy (LC) which has both somatic and visceral component. Interfascial plane blocks play a major role in Multimodal Analgesia (MMA). Previous studies have found good analgesic benefits with Erector Spinae Plane (ESP) and Oblique Subcostal Transversus Abdominis Plane (OSTAP) blocks. However, till date no study exists which compares the above blocks with addition of dexamethasone. Aim: To compare ESP with OSTAP block using low concentration of Local Anaesthetic (LA) and dexamethasone as part of MMA in elective LC. Materials and Methods: A total of 66 patients were included in this study and finally, 60 patients were analysed. They were randomised to receive either bilateral ESP at T7 level or bilateral OSTAP with 20 mL 0.2% ropivacaine and 4 mg dexamethasone before starting anaesthesia. Primary outcome measures were total opioid consumption and mean Visual Analog Scale (VAS) in the first 24 hours postoperatively. Secondary outcome measures were intraoperative opioid consumption, opioids or block related complication, and patients’ feedback for procedural satisfaction and postoperative pain control. The results were analysed using the Statistical Package for the Social Sciences (SPSS) software version 23.0. Continuous and categorical data were analysed using appropriate statistical analysis. A p-value <0.05 was considered statistically significant. Results: Both the blocks provided excellent pain relief. The mean (24 hours) opioid consumption in ESP group was 29.83±54.74 mg and in OSTAP group was 73.17±94.04 mg; p=0.034. The mean VAS was significantly lower in the ESP block at all point of time during first 24 hours in ESP group was 0.58 and in OSTAP group was 1.72 (p<0.001). The mean intraoperative opioid requirement in ESP and OSTAP group were 6.9±1.8 mg and 7.6±2.3 mg of nalbuphine, respectively. No complications were noted in any patients. Conclusion: Addition of dexamethasone in ESP block provides significant analgesia and less opioid consumption in patients undergoing LC. Hence, ESP block can be considered as part of MMA in LC surgery

Keywords

• laparoscopy
• multimodal approach
• nerve block
• ultrasound