Background and aims Total laparoscopic hysterectomy (TLH) is associated with significant postoperative pain which worsens outcomes and prolongs hospital stay.¹ The ultrasound guided (UG) erector spinae plane block (ESPB) is a new technique for thoracic analgesia.² Few cases have been reported for postoperative analgesia in laparoscopy.³ We describe the successful use of ESPB to provide postoperative analgesia following THL.

Methods We performed UG bilateral ESPB at T10 level in 10 patients scheduled for TLH after written informed consent. In sitting position, with a linear probe (Sonosite M-Turbo) and in plane cranio-caudal approach, Ropivacaine 0,5% 20 ml was injected bilaterally. Sensitive block was tested by pinprick. Standard Propofol-Sufentanil-Rocuronium-Sevoflurane general anaesthesia was administered. THL were performed with 12-mm umbilical trocar and 3 accessory 5-mm trocars. A patient control analgesia (PCA) with morphine was delivered. We measured postoperative pain by visual analogue scale (VAS).

Results Four patients underwent TLH, 6 women (60%) had TLH plus salpingo-oophorectomy. Intraoperative median sufentanil was 30 mcg (IQ 30–40). Pinprick was positive bilaterally T4-T10 in 3 patients (30%). VAS scores and Morphine consumption are listed in figure 1.

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Abstract ESRA19-0181 Figure 1

Graphics summarizing PostOperative (PO) Morphine consumption by Patient Controlled Analgesia and total morphine Consumption (A) and Visual Analogue Scale (VAS) (B).

Conclusions In literature 24-hour morphine consumption after TLH arise from 10,6 and 17,7 mg.⁴ ESPB was effective in reducing opioid requirement after TLH. Future research should compare ESPB to other techniques to assess its impact on intraoperative opioid consumption and hospital stay.

References

1. Lirk. Reg Anesth Pain Med. 2019 Apr;44(4):425–436.

2. Forero. Reg Anesth Pain Med. 2016; 41: 621–7.

3. Chin. Anaesthesia. 2017 Apr;72(4):452460.

4. Bacal. J Minim Invasive Gynecol. 2019;26:40–52.