Mounika Vaddamanu, Sahu Lingaraj, Mishra Krishna, Mohapatra Partha S
Department of Anesthesiology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND.
Department of Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND.
Cureus. 2023 Mar 4;15(3):e35750. doi: 10.7759/cureus.35750. eCollection 2023 Mar.
Introduction Acute pain following laparoscopic surgeries interferes with the rehabilitation of the patient. Knowledge about the pain pathway from a particular area helps in blocking pain transmission at different sites. Ultrasonography (USG)-guided peripheral nerve blocks help in controlling pain better than non-steroidal anti-inflammatory drugs (NSAIDS) and opioids since they directly act by interrupting the pain pathway and interfere less with the physiology of the body. This study was planned with the objectives to evaluate the analgesic efficacy of USG-guided erector spinae plane block (ESPB) and oblique subcostal transversus abdominis plane (OSTAP) block in patients undergoing elective laparoscopic cholecystectomy, to compare the analgesic requirements in both groups, and to compare the VAS scores in both groups. Materials and methods A total of 138 patients were randomized into two groups, with 69 patients in each group, and received either bilateral ESP (group 'E') or bilateral OSTAP (group 'O'). Those in group E received the block at the T7 level, and those in group O received the block in the subcostal region, with 20 ml of 0.2% ropivacaine and 4 mg of dexamethasone. The procedures were done after securing the airway. The total analgesic requirement and visual analogue scale (VAS) scoring in the first 24 hours post-operatively were observed, along with intra-operative opioid consumption. The opioid requirement, block-related complications, and patient feedback regarding post-operative pain control were also assessed. The results were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 23.0 (IBM Corp., Armonk, NY). Continuous and categorical data were analyzed using appropriate statistical analysis. A p-value <0.05 was considered statistically significant. Results The VAS scores were significantly lower during the first post-operative day in group E than in group O. In group E, VAS scoring was less than 4 for the first 24 hours post-surgery. In group O, VAS scores remained greater than or equal to 4 after four hours post-surgery, thereby indicating that the patients required opioids. Only seven patients in group E received tramadol, compared to 62 patients in group O. The mean tramadol requirement of seven patients in group 'E' was 65.71 ± 26.3 mg, and the mean tramadol requirement of 62 patients was 114.56 ± 36.8 mg (p = 0.0012). The patients in group 'O' demanded tramadol significantly more times than those in group 'E'. Conclusion It was concluded that USG-guided ESP block provides better pain control and decreases consumption of opioids post-operatively than OSTAP block in patients undergoing laparoscopic cholecystectomy surgeries. The block was found to be safe with no adverse effects, therefore it can be a part of multimodal analgesia.
腹腔镜手术后的急性疼痛会干扰患者的康复。了解特定区域的疼痛传导途径有助于在不同部位阻断疼痛传递。超声引导下的外周神经阻滞比非甾体抗炎药（NSAIDs）和阿片类药物能更好地控制疼痛，因为它们通过中断疼痛传导途径直接发挥作用，对身体生理功能的干扰较小。本研究旨在评估超声引导下竖脊肌平面阻滞（ESPB）和斜肋下腹横肌平面（OSTAP）阻滞对择期腹腔镜胆囊切除术患者的镇痛效果，比较两组的镇痛需求，并比较两组的视觉模拟评分（VAS）。
总共138例患者被随机分为两组，每组69例，分别接受双侧ESPB（E组）或双侧OSTAP（O组）。E组患者在T7水平进行阻滞，O组患者在肋下区域进行阻滞，使用20 ml 0.2%的罗哌卡因和4 mg地塞米松。在确保气道安全后进行操作。观察术后24小时内的总镇痛需求和视觉模拟量表（VAS）评分，以及术中阿片类药物的消耗量。还评估了阿片类药物的需求、与阻滞相关的并发症以及患者对术后疼痛控制的反馈。使用社会科学统计软件包（SPSS）23.0版（IBM公司，纽约州阿蒙克）对结果进行分析。连续数据和分类数据采用适当的统计分析方法。p值<0.05被认为具有统计学意义。
术后第一天，E组的VAS评分显著低于O组。在E组，术后24小时内VAS评分小于4。在O组，术后4小时后VAS评分仍大于或等于4，这表明患者需要使用阿片类药物。E组只有7例患者接受了曲马多，而O组有62例患者接受了曲马多。E组7例患者的曲马多平均需求量为65.71±26.3 mg，62例患者的曲马多平均需求量为114.56±36.8 mg（p = 0.0012）。O组患者比E组患者更频繁地需要曲马多。
得出结论，在接受腹腔镜胆囊切除术的患者中，超声引导下的ESPB阻滞比OSTAP阻滞能提供更好的疼痛控制，并减少术后阿片类药物的消耗量。该阻滞被发现是安全的，没有不良反应，因此可以成为多模式镇痛的一部分。
