Comparative Analysis of Ultrasound-Guided Erector Spinae Plane Block and Retro-laminar Block on Postoperative Pain Following Upper Abdominal Laparoscopic Surgery.

Abstract

Background: Postoperative pain following laparoscopic surgeries, such as laparoscopic cholecystectomy, can be severe. Despite various analgesic methods, high doses of narcotics are often required, leading to complications such as dizziness, respiratory disorders, and postoperative nausea and vomiting (PONV).

Objectives: The present study aimed to evaluate the efficacy of two novel analgesic methods, the erector spinae plane block (ESPB) and the retrolaminar block (RLB), performed under ultrasound guidance, in managing pain after upper abdominal laparoscopic surgeries.

Methods: In this clinical trial, candidates for elective upper abdominal laparoscopic surgeries were randomly assigned to two groups (40 patients in the ESPB group and 40 in the RLB group). To manage preoperative pain, one group received an ESPB block under ultrasound guidance on the surgical side, while the other group received a RLB. Both groups were equipped with a patient-controlled intravenous analgesia (PCIA) pump containing fentanyl. The analgesic used in both blocks was 0.1% ropivacaine (20 cc) on the surgical side. Patients' pain intensity [based on the Numeric Rating Scale (NRS)], need for additional narcotics, satisfaction, and sedation scores were recorded and analyzed at various time points post-surgery.

Results: There was no statistically significant difference in the demographic and baseline characteristics between the two groups. However, the average NRS score was significantly lower in the RLB group at all time points post-surgery, except immediately after surgery (P < 0.001). Patient satisfaction was higher in the RLB group at 20 minutes, 2 hours, 4 hours, and 6 hours post-surgery (P < 0.05). The RLB group also required fewer narcotics, indicating that the RLB is more effective in managing acute postoperative pain.

Conclusions: The RLB is more effective than the ESPB in reducing post-laparoscopic cholecystectomy pain. It also decreases narcotic consumption and associated complications. Therefore, it is recommended as a cost-effective method for managing acute pain after laparoscopic cholecystectomy.