Cesur Sevim, Y R Ko Lu Hadi Ufuk, Aksu Can, Ku Alparslan
Kocaeli University, School of Medicine, Department of Anesthesiology and Reanimation, Kocaeli, Turkey.
Bitlis Tatvan State Hospital, Clinic of Anesthesiology and Reanimation.
Braz J Anesthesiol. 2023 Jan-Feb;73(1):72-77. doi: 10.1016/j.bjane.2021.04.020. Epub 2021 Apr 28.
Laparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al., the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations.
This study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologists (ASA) physical status I.ÇôII, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups.
There was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6 hour (p = 0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p = 0.044 and p = 0.022, respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p = 0.011).
In conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.
腹腔镜胆囊切除术（LC）是治疗良性胆道疾病的常见外科手术。LC术后疼痛仍然是一个重要问题，它由两部分组成：躯体性疼痛和内脏性疼痛。套管针穿刺切口会导致躯体性疼痛，而腹膜扩张伴膈肌刺激会导致内脏性疼痛。在Forero等人对竖脊肌平面（ESP）阻滞进行描述后，该阻滞在临床医生中颇受欢迎。这导致ESP阻滞被用于各种手术的术后疼痛管理。
本研究于2019年1月至6月进行。纳入年龄在18至65岁之间、美国麻醉医师协会（ASA）身体状况为I或II级、计划行择期腹腔镜胆囊切除术的患者。所有患者根据分组在术前于T8水平接受双侧或单侧ESP阻滞。
除术后6小时外，在任何时间间隔，两组患者静息或咳嗽时的数字评分量表（NRS）评分均无显著差异（p = 0.023）。两组患者的吗啡用量相似，但B组在12小时和24小时时显著较低（分别为p = 0.044和p = 0.022）。A组有12例患者出现肩部疼痛，B组有3例患者出现肩部疼痛，差异有统计学意义（p = 0.011）。
总之，在接受择期LC的患者中，双侧ESP阻滞比单侧ESP阻滞提供了更有效的镇痛效果。双侧ESP阻滞减少了阿片类药物的用量和术后肩部疼痛的发生率。
