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Abstract
Background and Aims Laparoscopic cholecystectomy (LC) is one of the most common procedures performed by general surgeons. Postoperative pain can be moderate to severe, requiring administration of large doses of opioids. Erector Spinae Plane block (ESPB) is a trunk block performed as a method of postoperative analgesia in various surgical procedures. Its analgesic efficacy in LCs when dexmedetomidine is added in the local anesthetic mixture, has not been proven yet. In this study, we explored its efficacy as a perioperative analgesic method in patients undergoing LC.
Methods This study was designed as a double-blinded, randomized, controlled, prospective study. 60 patients were randomized into Group C: ESPB N/S 0,9%, Group D: ESPB ropivacaine 0,375%, dexmedetomidine 1 mcg/kg, Group R: ESPB ropivacaine 0,375%. ESPB was performed bilaterally before the induction of general anesthesia, with ultrasound guidance. Statistical analysis was performed with ANOVA, two-way ANOVA for repeated measures, Kruskal-Wallis, Spearman test.
Results All patients remained hemodynamically stable and no major complications were observed. Total intraoperative remifentanil was statistically different between the three groups. Median 24h morphine consumption, median NRS scores at all time points and mobilization time, were statistically different between Groups C and D, Groups C and R, but insignificant between Groups R and D. Satisfaction score was found to be statistically significant between Group C and D.
Conclusions ESPB performance with ropivacaine or ropivacaine/dexmedetomidine in patients scheduled for LC is a novel, safe and simple method, which can help improve the quality of analgesia, avoid the complications of opioid administration and thus achieve pre-emptive, multimodal and ‘opioid-free analgesia’.