Comparative Study between Erector Spinae Plane Block and Transversus Abdominis Plane Block for Postoperative Pain Management of Patients Undergoing Laparoscopic Cholecystectomy

Abstract Study Objective Laparoscopic cholecystectomy (LC) is a frequently applied minimally invasive surgery. Intraoperative access is provided with small keyhole entries on the abdominal wall. However, LC causes moderate to severe postoperative pain. Since the concept of day case surgeries are getting more popular, surgeons and anesthesiologists are trying their best to provide adequate post-operative analgesia. The proper management of post-operative pain ensures early ambulation of patients and obviates many post-operative complications. The subcostal approach of TAP block was described by Hebbard et al. for postoperative analgesia especially for upper abdominal surgeries. Ultrasound-guided erector spinae plane (US-ESP) block is a novel technique targeting ventral rami, dorsal rami of the spinal nerves. Design Prospective randomized, double blinded study. Setting After obtaining approval from the Research Medical Ethical Committee of Faculty of Medicine Ain shams University and obtaining an informed written consent from patients, this study will be conducted in the operating theatres of Ain shams University Hospitals. Patients Patients ASA 1 or 2 undergoing laparoscopic cholecystectomy. The patients will be randomly divided into two equal groups, They will be enrolled in group (1) for erector spinae plane block and group (2) for oblique subcostal transversus abdominis plane block. Each group contain 30 patients, 60 patients were included in final analysis Interventions Erector spinae plane block was performed in the ESP group and oblique subcostal transversus abdominis block was performed in the OSTAP group. Measurements Postoperative nalbuphine consumption and pain scores between groups were compared. Main Results Postoperative nalbuphine consumption was 18.31±5.11 mg in the ESP group and 30.51±9.19 mg in the OSTAP group ( p < 0.001). VAS scores at almost all time-points were lower in the ESP group according to the repeated measures analysis. Conclusion Ultrasound-guided ESP block reduced postoperative nalbuphine consumption and pain scores more effectively than OSTAP block after laparoscopic cholecystectomy surgery. This technique can be a promising mode of postoperative analgesia