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Abstract
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Background and Aims Incentive spirometry is a method commonly used for prevention of postoperative pulmonary complications in patients after abdominal surgery. However, pain after surgery can cause diminished incentive spirometry volumes. By effectively controlling postoperative pain, patient performance in incentive spirometry can be enhanced. The aim of this study is to determine whether erector spinae plane (ESP) block added to a standard analgesic regimen can improve incentive spirometry performance in patients after open abdominal surgery.
Methods This retrospective cohort study was approved by the Institutional Ethics Review Committee of St. Luke’s Medical Center. The records of 110 patients who underwent open abdominal surgery were reviewed. For the opioid-based group (n=55), a standard analgesic regimen of Paracetamol and a Non-steroidal Anti-inflammatory Drug (Parecoxib, Ketorolac or Dexketoprofen) was given in the first 24 hours post-surgery. Tramadol, Oxycodone, or Fentanyl was given as needed for breakthrough pain. For the ESP group (n=55), ultrasound-guided single shot bilateral ESP block with 0.2%-0.4% Ropivacaine was administered as an adjunct to the aforementioned standard analgesic regimen. The first recorded incentive spirometry scores in the first 24 hours postoperatively were compared between the two groups.
Results Mean peak effort volume on incentive spirometry within 24 hours postoperatively was significantly higher with the ESP group (1212.7 ml +/- 523.4 ml) compared to the opioid-based group (541.8 ml +/- 437.7 ml) with p-value <0.001 (figure 1).
Conclusions Addition of ESP block to the analgesic regimen of patients undergoing abdominal surgeries facilitates more effective incentive spirometry compared to an opioid-based analgesic regimen alone.
Comparison of mean incentive spirometry volumes in opioid-based group versus ESP group