Background: Spinal anesthesia is associated with intraoperative hypotension so it is unsuitable for hemodynamically unstable patients. Intraoperative gas insufflation, artificial pneumoperitoneum compression and diaphragmatic displacement increase intrathoracic pressure and reduce preload. Postoperative analgesia in laparoscopic cholecystectomy has seen a recent uptick in popularity after the introduction of the Erector Spinae Plane Block. One main way that local anesthetics work is by physically spreading and diffusing to neuronal structures in the fascial plane, which in turn affects the erector spinae muscles and other tissue compartments. By using ultrasound, regional blocks may be performed more quickly, with fewer needle pricks, and with a shorter onset time.
Aims: The purpose of this study is to evaluate the efficacy of
standard intravenous opioids vs an ultrasound-guided bilateral erector spinae
plane block in elective laparoscopic cholecystectomies for postoperative pain
management.
Materials and Methods: This is a Randomized controlled trial done
in the Department of Anesthesiology, conducted at NKPSIMS and RC and LMC,
Nagpur, a tertiary care center, patients undergoing elective laparoscopic cholecystectomies
under general anesthesia from November 2022 to May 2024. A total consecutive
sample of 56 participants fulfilling eligibility criteria was selected by
convenience sampling method. Using Pearson's chi-square test, the percentages
of two sets of qualitative criteria were compared. All comparisons were deemed
statistically significant when the P value was less than 0.05.
Results: Most of the patients come under 51-60 years of age. Group
B: Ages 22-66 years, mean 44.96 years, SD 13.52 years. Group O: Ages 20-66
years, mean 42.54 years, SD 12.32 years. Group B: 42.86% males, 57.14% females.
Group O: 39.29% males, 60.71% females. Patients are not statistically
significant with respect to height, weight and BMI. ASA Classification, Group
B: 57.14% Grade I, 42.86% Grade II Group O: 53.57% Grade I, 46.43% Grade II.
Duration of Pneumoperitoneum Group B: Range 1.25-3 hours, mean 2.05 hours, SD
0.43 hours Group O: Range 1.5-3 hours, mean 2.25 hours, SD 0.45 hours. Duration
of Anesthesia Group B: Range 2-3.5 hours, mean 2.59 hours, SD 0.4 hours. Group
O: Range 2-3.5 hours, mean 2.77 hours, SD 0.44 hours. There is no statistical
significance respected to intraoperative hemodynamic events. Significant
differences in intraoperative hemodynamic events, additional treatment
requirements, rescue analgesia, and side effects underscore the importance of
advanced analgesic techniques in improving patient outcomes. These comparative
insights provide valuable context for our results and suggest avenues for
future research and clinical practice improvements.
Conclusion: Group B significantly outperformed Group O in terms of
intraoperative hemodynamic stability, and they needed less supplemental therapy
and rescue analgesia overall. “There was a marked decrease in postoperative
nausea and vomiting in Group B. The results of this study highlight the need to
include ESP Blocks in the pain management plans of patients undergoing
laparoscopic cholecystectomy procedures. When it comes to elective laparoscopic
cholecystectomy, the ultrasound-guided bilateral erector spinae plane block
seems to be a great way to improve perioperative outcomes, provide better
hemodynamic stability, lessen the need for postoperative pain medication, and
decrease the occurrence of postoperative complications. The technique could
potentially enhance patient comfort and satisfaction, leading to better overall
surgical outcomes.
Author
(s) Details
Ketaki Marodkar
Department of Anesthesiology, NKP Salve Institute of Medical Sciences and
Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra- 440019,
India.
Ankita Agrawal
Department of Anesthesiology, NKP Salve Institute of Medical Sciences and
Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra- 440019,
India.
Rutuja Chati
Department of Anesthesiology, NKP Salve Institute of Medical Sciences and
Research Centre and Lata Mangeshkar
Hospital, Nagpur, Maharashtra- 440019, India.
Please see the book here:- https://doi.org/10.9734/bpi/acmms/v10/3631
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