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Abstract
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Background and Aims Postoperative pain management following laparoscopic liver resection remains a significant challenge despite advancements in anesthesia techniques. This study aimed to investigate whether a single-shot erector spinae plane block (ESPB) or posterior quadratus lumborum block (QLB) could enhance postoperative analgesia in the first 24 h after surgery.
Methods A prospective, double-blinded, randomized controlled trial was conducted at a single tertiary care center between August 2022 and January 2024. One hundred fourteen patients scheduled for laparoscopic major liver resection due to malignancy were recruited. Patients were randomly assigned to the control, ESPB, or QLB group in a 1:1:1 ratio. Both the ESPB and QLB groups received 40 mL of 0.5% ropivacaine (20 mL on each side). The primary outcome was cumulative opioid consumption during the first 24 h after surgery. Secondary outcomes included pain scores and intraoperative and recovery parameters.
Results The average cumulative opioid consumption at 24 h after surgery was comparable among the groups. No significant intergroup differences were observed in cumulative opioid consumptions at all time-points (figure 1). Pain at rest was significantly different in the PACU (PACU admission: P = 0.012; PACU worst pain: P = 0.012; PACU discharge: P = 0.006) and at 48h after surgery (P = 0.006). For pain when coughing, differences among the three groups were noted only at PACU admission and PACU worst pain (P = 0.002, P = 0.006, respectively)
Cumulative opioid consumption during 72 h after surgery. Cumulative opioid consumption is converted to intravenous morphine equivalent dose
Conclusions Neither ESPB nor posterior QLB significantly reduced the cumulative opioid consumption at 24 h after laparoscopic major liver resection.