Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-77756 | DOI: 10.14744/tjtes.2024.77756

Comparison of Erector Spinae Plane Block and Rectus Sheath Block for Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy: A Retrospective Non-Inferiority Study

Mete Manýcý¹, Ilayda Kalyoncu¹, Merve Ümran Yýlmaz¹, Ergün Mendeþ¹, Derya Salim Uymaz², Emre Balýk², Yavuz Gürkan^1
1Department of Anesthesiology and Reanimation, Koç University Faculty of Medicine Hospital, Istanbul, Türkiye
²Department of General Surgery, Koç University Faculty of Medicine Hospital, Istanbul,Türkiye

Background: Management of analgesia after laparoscopic cholecystectomy (LC) is critical to ensure optimal comfort and recovery. In this study, the effects of erector spinae plane block (ESPB) and rectus sheath block (RSB) on opioid consumption were assessed for non-inferiority.
Methods: In this retrospective study, 44 patients between the ages of 18 and 75 who underwent LC at our hospital between December 2022 and March 2023 and had an American Society of Anesthesiology (ASA) score of I-II were evaluated. Patients were divided into two groups: ESPB (n=24) and RSB (n=20). Preoperative bilateral 20 mL 0.25% bupivacaine was administered to the ESPB group and postoperative bilateral 20 mL 0.25% bupivacaine was administered to the RSB group. The primary outcome measure was opioid consumption in the first 24 hours after surgery.
Results: The RSB and ESPB groups were similar demographically. Opioid consumption in the first 24 hours was 6.29 ± 1.73 mg in the ESPB group and 6.60 ± 3.41 mg in the RSB group, and there was no significant difference between the two groups (95% CI -1.64 to 1.02; p = 0.717). Opioid consumption in the RSB group was similar to that in the ESBP group when the equivalence margin was set at -2 mg. Three patients in the ESPB group and five patients in the RSB group required fentanyl rescue analgesia in the postoperative care unit (p=0.400). The groups were similar in terms of VAS pain scores and the number of patients who developed nausea/vomiting in the first 24 hours postoperatively (p>0.05).
Conclusion: ESPB and RSB demonstrated comparable analgesic efficacy, and RSB was found to be non-inferior to ESPB in LC surgery in terms of 24-hour opioid consumption. The groups were found to be similar in terms of rescue analgesia, VAS scores, shoulder pain, and frequency of nausea and vomiting.

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

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Laparoskopik Kolesistektomi Uygulanan Hastalarda Postoperatif Analjezi Ýçin Erektör Spina Düzlem Bloðu ve Rektus Kýlýf Bloðunun Karþýlaþtýrýlmasý: Retrospektif Eþdeðerlik Çalýþmasý

Mete Manýcý¹, Ilayda Kalyoncu¹, Merve Ümran Yýlmaz¹, Ergün Mendeþ¹, Derya Salim Uymaz², Emre Balýk², Yavuz Gürkan^1
1Anesteziyoloji ve Reanimasyon Anabilim Dalý, Koç Üniversitesi Týp Fakültesi Hastanesi, Ýstanbul, Türkiye
²Genel Cerrahi Anabilim Dalý, Koç Üniversitesi Týp Fakültesi Hastanesi, Istanbul,Türkiye

Amaç: Laparoskopik kolesistektomi (LK) sonrasý analjezi yönetimi, optimal konfor ve iyileþmeyi saðlamak için kritik öneme sahiptir. Bu çalýþmada, erektör spina düzlem bloðu (ESPB) ve rektus kýlýf bloðunun (RSB) opioid tüketimi üzerindeki etkileri eþdeðerlik açýsýndan deðerlendirildi.
Gereç ve Yöntem: Bu retrospektif çalýþmada, Aralýk 2022 ile Mart 2023 tarihleri arasýnda hastanemizde LK operasyonu geçiren, Amerikan Anesteziyoloji Derneði (ASA) skoru I-II olan, 18-75 yaþ aralýðýndaki 44 hasta deðerlendirildi. Hastalar ESPB (n=24) ve RSB (n=20) olmak üzere iki gruba ayrýldý. ESPB grubuna preoperatif bilateral 20 mL %0.25 bupivakain, RSB grubuna postoperatif bilateral 20 mL %0.25 bupivakain uygulandý. Birincil sonuç ölçütü ameliyattan sonraki ilk 24 saat içindeki opioid tüketimiydi.
Bulgular: RSB ve ESPB gruplarý demografik olarak benzerdi. Ýlk 24 saatteki opioid tüketimi ESPB grubunda 6.29 ± 1.73 mg, RSB grubunda ise 6.60 ± 3.41 mg olmuþ ve iki grup arasýnda anlamlý fark görülmedi (%95 GA -1.64 ila 1.02; p = 0.717). Eþdeðerlik marjin sýnýrý -2 mg olarak alýndýðýnda, RSB grubundaki opioid tüketiminin ESBP grubuna benzer olduðu görüldü. ESPB grubunda üç hasta ve RSB grubunda beþ hastaya ameliyat sonrasý bakým ünitesinde fentanil kurtarma analjezisi gerektirdi (p=0,400). Gruplar VAS aðrý skorlarý ve ameliyat sonrasý ilk 24 saatte bulantý/kusma geliþen hasta sayýsý açýsýndan benzerdi (p>0.05).
Sonuç: ESPB ve RSB'nin karþýlaþtýrýlabilir analjezik etkinlik gösterdiði ve RSB'nin 24 saatlik opioid tüketimi açýsýndan LK cerrahisinde ESPB'den daha düþük olmadýðý bulundu. Gruplarýn kurtarma analjezisi, VAS skorlarý, omuz aðrýsý, bulantý-kusma sýklýðý açýsýndan benzer olduðu görüldü.

Anahtar Kelimeler: laparoskopik kolesistektomi, erektör spina düzlem bloðu, rektus kýlýf bloðu, postoperatif analjezi, opioid tüketimi

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