Laparoskopik kolesistektomi uygulanan hastalarda postoperatif analjezi i�in erekt�r spina d�zlem blo�u ve rektus k�l�f blo�unun kar��la�t�r�lmas�: Retrospektif e�de�erlik �al��mas�

Man�c�, Mete; Kalyoncu, Ilayda; Y�lmaz, Merve �mran; Mende�, Erg�n; Uymaz, Derya Salim; Bal�k, Emre; G�rkan, Yavuz

Cilt : 31 Say� : 3 Y�l : 2025

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Laparoskopik kolesistektomi uygulanan hastalarda postoperatif analjezi i�in erekt�r spina d�zlem blo�u ve rektus k�l�f blo�unun kar��la�t�r�lmas�: Retrospektif e�de�erlik �al��mas� [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2025; 31(3): 242-248 | DOI: 10.14744/tjtes.2024.77756

Laparoskopik kolesistektomi uygulanan hastalarda postoperatif analjezi i�in erekt�r spina d�zlem blo�u ve rektus k�l�f blo�unun kar��la�t�r�lmas�: Retrospektif e�de�erlik �al��mas�

Mete Man�c�¹, Ilayda Kalyoncu¹, Merve �mran Y�lmaz¹, Erg�n Mende�¹, Derya Salim Uymaz², Emre Bal�k², Yavuz G�rkan¹
¹Anesteziyoloji ve Reanimasyon Anabilim Dal�, Ko� �niversitesi T�p Fak�ltesi Hastanesi, �stanbul-Türkiye
²Genel Cerrahi Anabilim Dal�, Ko� �niversitesi T�p Fak�ltesi Hastanesi, �stanbul-Türkiye

AMA�: Laparoskopik kolesistektomi (LK) sonras� analjezi y�netimi, optimal konfor ve iyile�meyi sa�lamak i�in kritik �neme sahiptir. Bu �al��mada, erekt�r spina d�zlem blo�u (ESPB) ve rektus k�l�f blo�unun (RSB) opioid t�ketimi �zerindeki etkileri e�de�erlik a��s�ndan de�erlendirildi.
GERE� VE Y�NTEM: Bu retrospektif �al��mada, Aral�k 2022 ile Mart 2023 tarihleri aras�nda hastanemizde LK operasyonu ge�iren, Amerikan Anesteziyoloji Derne�i (ASA) skoru I-II olan, 18-75 ya� aral��ndaki 44 hasta de�erlendirildi. Hastalar ESPB (n=24) ve RSB (n=20) olmak �zere iki gruba ayr�ld�. ESPB grubuna preoperatif bilateral 20 mL %0.25 bupivakain, RSB grubuna postoperatif bilateral 20 mL %0.25 bupivakain uyguland�. Birincil sonu� �l��t� ameliyattan sonraki ilk 24 saat i�indeki opioid t�ketimiydi.
BULGULAR: RSB ve ESPB gruplar� demografik olarak benzerdi. �lk 24 saatteki opioid t�ketimi ESPB grubunda 6.29�1.73 mg, RSB grubunda ise 6.60 �3.41 mg olmu� ve iki grup aras�nda anlaml� fark g�r�lmedi (%95 GA -1.64 ila 1.02; p=0.717). E�de�erlik marjin s�n�r� -2 mg olarak al�nd��nda, RSB grubundaki opioid t�ketiminin ESBP grubuna benzer oldu�u g�r�ld�. ESPB grubunda �� hasta ve RSB grubunda be� hastaya ameliyat sonras� bak�m �nitesinde fentanil kurtarma analjezisi gerektirdi (p=0.400). Gruplar VAS a�r� skorlar� ve ameliyat sonras� ilk 24 saatte bulant�/kusma geli�en hasta say�s� a��s�ndan benzerdi (p>0.05).
SONU�: ESPB ve RSB'nin kar��la�t�r�labilir analjezik etkinlik g�sterdi�i ve RSB'nin 24 saatlik opioid t�ketimi a��s�ndan LK cerrahisinde ESPB'den daha d��k olmad�� bulundu. Gruplar�n kurtarma analjezisi, VAS skorlar�, omuz a�r�s�, bulant�-kusma s�kl�� a��s�ndan benzer oldu�u g�r�ld�.

Anahtar Kelimeler: Laparoskopik kolesistektomi, erekt�r spina d�zlem blo�u, rektus k�l�f blo�u, postoperatif analjezi, opioid t�ketimi

Comparison of erector spinae plane block and rectus sheath block for postoperative analgesia in patients undergoing laparoscopic cholecystectomy: A retrospective non-inferiority study

Mete Man�c�¹, Ilayda Kalyoncu¹, Merve �mran Y�lmaz¹, Erg�n Mende�¹, Derya Salim Uymaz², Emre Bal�k², Yavuz G�rkan¹
¹Department of Anesthesiology and Reanimation, Ko� University Faculty of Medicine Hospital, �stanbul-Türkiye
²Department of General Surgery, Ko� University Faculty of Medicine Hospital, �stanbul-Türkiye

BACKGROUND: Effective management of postoperative analgesia following laparoscopic cholecystectomy (LC) is critical to ensure optimal patient comfort and recovery. This study evaluates the effects of erector spinae plane block (ESPB) and rectus sheath block (RSB) on opioid consumption to determine non-inferiority.
METHODS: This retrospective study analyzed 44 patients aged 18 to 75 years who underwent LC at our hospital between December 2022 and March 2023, with American Society of Anesthesiologists (ASA) scores of I-II. Patients were divided into two groups: ESPB (n=24) and RSB (n=20). The ESPB group received a preoperative bilateral injection of 20 mL of 0.25% bupivacaine, while the RSB group received a postoperative bilateral injection of 20 mL of 0.25% bupivacaine. The primary outcome measure was opioid consumption within the first 24 hours postoperatively.
RESULTS: The demographic characteristics of the RSB and ESPB groups were similar. Opioid consumption during the first 24 hours was 6.29�1.73 mg in the ESPB group and 6.60�3.41 mg in the RSB group, with no statistically significant difference between the two groups (95% confidence interval [CI]: -1.64 to 1.02; p=0.717). When the equivalence margin was set at -2 mg, opioid consumption in the RSB group was found to be similar to that in the ESPB group. Fentanyl rescue analgesia in the postoperative care unit was required by three patients in the ESPB group and five patients in the RSB group (p=0.400). Visual Analog Scale (VAS) pain scores and the number of patients who developed nausea and vomiting in the first 24 hours postoperatively were similar between the groups (p>0.05).
CONCLUSION: The erector spinae plane block and RSB demonstrated comparable analgesic efficacy. Rectus sheath block was found to be non-inferior to ESPB in LC surgery with respect to 24-hour opioid consumption. The groups were also similar regarding rescue analgesia, VAS scores, shoulder pain, and the frequency of nausea and vomiting.

Keywords: Laparoscopic cholecystectomy, erector spinae plane block, rectus sheath block, postoperative analgesia, opioid consumption

Sorumlu Yazar: Erg�n Mende�, T�rkiye
Makale Dili: �ngilizce

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