Sahin Murat, Surhan Cinar A, Mustafa Altinay, Ilay Cetiner, Ozge Uyanikoglu, Sinan Omeroglu
Department of Anaesthesia and Intensive Care Medicine Sisli Hamidiye Etfal Teaching and Research Hospital Istanbul, University of Health Sciences.
Department of General Surgery Sisli Hamidiye Etfal Teaching and Research Hospital Istanbul, University of Health Sciences, Istanbul, Turkey.
Surg Laparosc Endosc Percutan Tech. 2025 Jun 1;35(3):e1373. doi: 10.1097/SLE.0000000000001373.
After laparoscopic cholecystectomy surgery, an increase in stress hormones and moderate-to-severe pain occur in the postoperative period. The aim is to compare the effects of unilateral erector spinae plane block (ESPB) and port site local anesthetic (LA) infiltration methods on stress hormone response and postoperative pain in laparoscopic cholecystectomy operations.
This study was a prospective, randomized controlled, single-blind trial that divided laparoscopic cholecystectomy patients into 3 groups. In group I, local anesthetic infiltration was administered at 4 trocar sites; group E underwent unilateral ESPB guided by ultrasound; and group C was the control group with no intervention. Stress hormones were measured preoperatively and postoperatively, and postoperative VAS scores were recorded. The primary outcome was to compare the effects of LA infiltration and ESPB on stress hormone response, while the secondary outcome was the efficacy of postoperative analgesia.
A total of 90 patients were included in the study. The duration of analgesia was significantly longer in group I compared with group C ( P <0.05). Postoperative VAS scores were significantly lower in group E and group I than in group C ( P <0.05). Group E significantly suppressed prolactin levels compared with the other 2 groups ( P <0.05). In addition, group E significantly reduced glucose levels compared with group C ( P <0.05).
Unilateral ESPB and infiltration have similar effects on pain and stress hormones after laparoscopic cholecystectomy. Infiltration may be preferred due to its easier application.
腹腔镜胆囊切除术后，术后会出现应激激素增加和中重度疼痛。目的是比较单侧竖脊肌平面阻滞（ESPB）和切口局部麻醉（LA）浸润方法对腹腔镜胆囊切除术患者应激激素反应和术后疼痛的影响。
本研究为前瞻性、随机对照、单盲试验，将腹腔镜胆囊切除术患者分为3组。第一组在4个套管针穿刺部位进行局部麻醉浸润；E组在超声引导下进行单侧ESPB；C组为对照组，不进行干预。术前和术后测量应激激素，并记录术后视觉模拟评分（VAS）。主要结局是比较LA浸润和ESPB对应激激素反应的影响，次要结局是术后镇痛效果。
本研究共纳入90例患者。第一组的镇痛持续时间明显长于C组（P<0.05）。E组和第一组的术后VAS评分明显低于C组（P<0.05）。与其他两组相比，E组显著抑制了催乳素水平（P<0.05）。此外，与C组相比，E组显著降低了血糖水平（P<0.05）。
单侧ESPB和浸润对腹腔镜胆囊切除术后的疼痛和应激激素有相似的影响。由于浸润操作更简便，可能更受青睐。
