DOI QR코드

DOI QR Code

Comparison of the efficacy of erector spinae plane block according to the difference in bupivacaine concentrations for analgesia after laparoscopic cholecystectomy: a retrospective study

  • Yoo Jung Park (Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Sujung Chu (Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Eunju Yu (Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jin Deok Joo (Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea)
  • 투고 : 2022.07.15
  • 심사 : 2022.08.04
  • 발행 : 2023.04.30

초록

Background: Laparoscopic cholecystectomy (LC) is a noninvasive surgery, but postoperative pain is a major problem. Studies have indicated that erector spinae plane block (ESPB) has an analgesic effect after LC. We aimed to compare the efficacy of different ESPB anesthetic concentrations in pain control in patients with LC. Methods: This retrospective study included patients aged 20 to 75 years scheduled for LC with the American Society of Anesthesiologists physical status classification I or II. ESPB was administered using 0.375% bupivacaine in group 1 and 0.25% in group 2. Both groups received general anesthesia. Postoperative tramadol consumption and pain scores were compared and intraoperative and postoperative fentanyl requirements in the postanesthesia care unit (PACU) were measured. Results: Eighty-five patients were included in this analysis. Tramadol consumption in the first 12 hours, second 12 hours, and total 24 hours was similar between groups (p>0.05). The differences between postoperative numeric rating scale (NRS) scores at rest did not differ significantly. The postoperative NRS scores upon bodily movement were not statistically different between the two groups, except at 12 hours. The mean intraoperative and postoperative fentanyl requirements in the PACU were similar. The difference in the requirement for rescue analgesics was not statistically significant (p=0.788). Conclusion: Ultrasound-guided ESPB performed with different bupivacaine concentrations was effective in both groups for LC analgesia, with similar opioid consumption. A lower concentration of local anesthetic can be helpful for the safety of regional anesthesia and is recommended for the analgesic effect of ESPB in LC.

키워드

참고문헌

  1. Alexander JI. Pain after laparoscopy. Br J Anaesth 1997;79:369-78. https://doi.org/10.1093/bja/79.3.369
  2. Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology 2013;118:934-44. https://doi.org/10.1097/ALN.0b013e31828866b3
  3. Shin HJ, Oh AY, Baik JS, Kim JH, Han SH, Hwang JW. Ultrasound-guided oblique subcostal transversus abdominis plane block for analgesia after laparoscopic cholecystectomy: a randomized, controlled, observer-blinded study. Minerva Anestesiol 2014;80:185-93.
  4. Kehlet H. Postoperative pain, analgesia, and recovery-bedfellows that cannot be ignored. Pain 2018;159(9 Suppl 1):S11-6. https://doi.org/10.1097/j.pain.0000000000001243
  5. Fregoso G, Wang A, Tseng K, Wang J. Transition from acute to chronic pain: evaluating risk for chronic postsurgical pain. Pain Physician 2019;22:479-88.
  6. Safa R, Sadovnikoff N. Anesthesia for patients with concomitant cardiac and renal dysfunction. Anesthesiol Clin 2016;34:697-710. https://doi.org/10.1016/j.anclin.2016.06.006
  7. Erol DD, Yilmaz S, Polat C, Arikan Y. Efficacy of thoracic epidural analgesia for laparoscopic cholecystectomy. Adv Ther 2008;25:45-52. https://doi.org/10.1007/s12325-008-0005-2
  8. Aydin G, Aydin O. The efficacy of ultrasound-guided paravertebral block in laparoscopic cholecystectomy. Medicina (Kaunas) 2018;54:75.
  9. Altiparmak B, Korkmaz Toker M, Uysal AI, Kuscu Y, Gumus Demirbilek S. Ultrasound-guided erector spinae plane block versus oblique subcostal transversus abdominis plane block for postoperative analgesia of adult patients undergoing laparoscopic cholecystectomy: randomized, controlled trial. J Clin Anesth 2019;57:31-6. https://doi.org/10.1016/j.jclinane.2019.03.012
  10. Aygun H, Kavrut Ozturk N, Pamukcu AS, Inal A, Kiziloglu I, Thomas DT, et al. Comparison of ultrasound guided erector spinae plane block and quadratus lumborum block for postoperative analgesia in laparoscopic cholecystectomy patients; a prospective randomized study. J Clin Anesth 2020;62:109696.
  11. Tulgar S, Kapakli MS, Senturk O, Selvi O, Serifsoy TE, Ozer Z. Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a prospective, randomized, controlled clinical trial. J Clin Anesth 2018;49:101-6. https://doi.org/10.1016/j.jclinane.2018.06.019
  12. Cesur S, Y R Ko Lu HU, Aksu C, Ku A. Bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled study. Braz J Anesthesiol 2023;73:72-7. https://doi.org/10.1016/j.bjane.2021.04.020
  13. Vrsajkov V, Ilic N, Uvelin A, Ilic R, Lukic-Sarkanovic M, Plecas-Duric A. Erector spinae plane block reduces pain after laparoscopic cholecystectomy. Anaesthesist 2021;70(Suppl 1):48-52. https://doi.org/10.1007/s00101-021-01015-5
  14. Ozdemir H, Araz C, Karaca O, Turk E. Comparison of ultrasound-guided erector spinae plane block and subcostal transversus abdominis plane block for postoperative analgesia after laparoscopic cholecystectomy: a randomized, controlled trial. J Invest Surg 2022;35:870-7. https://doi.org/10.1080/08941939.2021.1931574
  15. Liu H, Brown M, Sun L, Patel SP, Li J, Cornett EM, et al. Complications and liability related to regional and neuraxial anesthesia. Best Pract Res Clin Anaesthesiol 2019;33:487-97. https://doi.org/10.1016/j.bpa.2019.07.007
  16. Albrecht E, Chin KJ. Advances in regional anaesthesia and acute pain management: a narrative review. Anaesthesia 2020;75(Suppl 1):e101-10. https://doi.org/10.1111/anae.14868
  17. Blichfeldt-Eckhardt MR, Ording H, Andersen C, Licht PB, Toft P. Early visceral pain predicts chronic pain after laparoscopic cholecystectomy. Pain 2014;155:2400-7. https://doi.org/10.1016/j.pain.2014.09.019
  18. Kumar K, Kirksey MA, Duong S, Wu CL. A review of opioid-sparing modalities in perioperative pain management: methods to decrease opioid use postoperatively. Anesth Analg 2017;125:1749-60. https://doi.org/10.1213/ANE.0000000000002497
  19. Daghmouri MA, Akremi S, Chaouch MA, Mesbahi M, Amouri N, Jaoua H, et al. Bilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials. Pain Pract 2021;21:357-65. https://doi.org/10.1111/papr.12953
  20. Rosenberg PH, Veering BT, Urmey WF. Maximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med 2004;29:564-75. https://doi.org/10.1097/00115550-200411000-00010
  21. Barrington MJ, Watts SA, Gledhill SR, Thomas RD, Said SA, Snyder GL, et al. Preliminary results of the Australasian Regional Anaesthesia Collaboration: a prospective audit of more than 7000 peripheral nerve and plexus blocks for neurologic and other complications. Reg Anesth Pain Med 2009;34:534-41. https://doi.org/10.1097/AAP.0b013e3181ae72e8
  22. Barrington MJ, Kluger R. Ultrasound guidance reduces the risk of local anesthetic systemic toxicity following peripheral nerve blockade. Reg Anesth Pain Med 2013;38:289-99. https://doi.org/10.1097/AAP.0b013e318292669b
  23. El-Boghdadly K, Pawa A. The erector spinae plane block: plane and simple. Anaesthesia 2017;72:434-8. https://doi.org/10.1111/anae.13830
  24. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016;41:621-7. https://doi.org/10.1097/AAP.0000000000000451
  25. Murouchi T, Iwasaki S, Yamakage M. Chronological changes in ropivacaine concentration and analgesic effects between transversus abdominis plane block and rectus sheath block. Reg Anesth Pain Med 2015;40:568-71. https://doi.org/10.1097/AAP.0000000000000288
  26. Toju K, Shiraishi K, Hakozaki T, Isosu T, Murakawa M. Plasma ropivacaine concentration following ultrasound-guided subcostal transversus abdominis plane block in adults. J Anesth 2015;29:146-8. https://doi.org/10.1007/s00540-014-1864-0
  27. El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: current perspectives. Local Reg Anesth 2018;11:35-44. https://doi.org/10.2147/LRA.S154512
  28. Miranda P, Corvetto MA, Altermatt FR, Araneda A, Echevarria GC, Cortinez LI. Levobupivacaine absorption pharmacokinetics with and without epinephrine during TAP block: analysis of doses based on the associated risk of local anaesthetic toxicity. Eur J Clin Pharmacol 2016;72:1221-7. https://doi.org/10.1007/s00228-016-2086-1
  29. Hamilton DL. Pneumothorax following erector spinae plane block. J Clin Anesth 2019;52:17.
  30. Piraccini E, Poggi P, Maitan S. An alternative approach to reduce the risk of pneumothorax during erector spinae plane block in low thoracic vertebral levels. J Clin Anesth 2020;59:14-5. https://doi.org/10.1016/j.jclinane.2019.06.005
  31. Macfarlane AJ, Gitman M, Bornstein KJ, El-Boghdadly K, Weinberg G. Updates in our understanding of local anaesthetic systemic toxicity: a narrative review. Anaesthesia 2021;76(Suppl 1):27-39. https://doi.org/10.1111/anae.15282
  32. Apfel CC, Heidrich FM, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth 2012;109:742-53. https://doi.org/10.1093/bja/aes276
  33. Lee DH, Song T, Kim KH, Lee KW. Incidence, natural course, and characteristics of postlaparoscopic shoulder pain. Surg Endosc 2018;32:160-5. https://doi.org/10.1007/s00464-017-5651-5
  34. Barazanchi AW, MacFater WS, Rahiri JL, Tutone S, Hill AG, Joshi GP, et al. Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update. Br J Anaesth 2018;121:787-803. https://doi.org/10.1016/j.bja.2018.06.023