Comparison of Postoperative Analgesic Effects of Bilateral Erector Spinae Plane Block Guided by Ultrasonography with Traditional Intravenous Opioids in Elective Laparoscopic Cholecystectomy: A Randomized Controlled Study | Chapter 11 | Achievements and Challenges of Medicine and Medical Science Vol. 10

 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

Comparison of Efficacy between Retro-Clavicular and Coracoid Approach of Infraclavicular Brachial Plexus Block under Ultrasound Guidance for Upper Limb Surgeries: A Randomised Controlled Study | Chapter 1 | Achievements and Challenges of Medicine and Medical Science Vol. 10

Background: Ultrasound guidance has transformed the way peripheral nerve blocks are performed; the supraclavicular block is the best location to produce anaesthesia across the entire upper limb.  Numerous methods for implementing infraclavicular brachial plexus block have been reported in the literature and the three most common approaches are the coracoid approach, lateral sagittal approach and vertical approach. The retro clavicular approach to infraclavicular block presents several advantages over the coracoid approach such as better needle tip and shaft visibility, reduced performance time and anaesthesia-related time, less paraesthesia during block performance, and fewer needle passes than the coracoid approach.

Aims: The aim of the study is to compare the efficacy between the retro clavicular and coracoid approach of infraclavicular brachial plexus block under ultrasound guidance for upper limb surgeries.

Methods and Materials: This was a hospital-based randomized controlled study conducted at NKPSIMS and RC and LMC, Nagpur from 28-9-2022 to 31-8-2024 in total of 64 patients. Detailed medical history was obtained, physical examination was done, and required investigations were attended. Group R (study group): received infraclavicular block through retro clavicular approach and Group C (Control group): received infraclavicular block through coracoid approach with 10 ml of 0.5% Bupivacaine and 10 ml of 2% lignicaine plus adrenaline. Data was coded and analysed in statistical software STATA version 10.1, 2011. The difference in proportions up to qualitative parameters was assessed with Pearson chi-square test. P value less than 0.05 was considered statistically significant.

Results: In our study, group R (mean age+/-SD-40.48+/-13.81) and group C (mean age+/-SD--36.75+/-12.78) with a P value of 0.67. group R (female-25%, Male-75%) and group C (female-18.75%, male-81.25%). There was no statistically significant in ASA status, or BMI between both groups. There was statistically highly significant in block performance time [P value 0.0001], number of attempts [P value 0.01], sensory and motor onset time and complete sensory loss and motor paralysis time between groups [P value 0.001]. There was no statistically significant difference in terms of the need for supplemental analgesia and sparing of nerve [P value 0.30], and no statistically significant difference in terms of complications like vascular puncture, and Horner syndrome [P value 0.30].

Conclusion: Regional Anesthesia (RA) or the action of blocking nerve conduction temporarily, has been performed since the beginning of surgical interventions described in humans. It is concluded that in ASA status class I/ II/III non-obese adults undergoing elective upper limb surgeries, retro clavicular approach to infraclavicular brachial plexus block is a promising alternative to coracoid approach in terms of a faster block performance time, lesser number of attempts required for block, better sensory block times and comparable success rates and equal complication risk parameters. The reasons for better block parameters in the retro clavicular approach may be due to better needle visibility, perpendicular needle insertion path to the USG beam and the presence of a lesser number of neurovascular structures in the needle path diminishing the incidence of block-related complications. Thus, this block can be used effectively for upper limb anaesthesia in adults in whom limb abduction is difficult.

 

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.

 

Rutuja Chati
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.

 

Please see the book here:- https://doi.org/10.9734/bpi/acmms/v10/3632