Does Erector Spinae Plane Block Have a Visceral Analgesic Effect?: A Randomized Controlled Trial

Abstract

The visceral analgesic efficacy of erector spinae plane block (ESPB) is still a matter of debate. This study attempted to investigate the visceral analgesic efficacy of ESPB in clinical setting. After randomized, we performed ultrasound-guided bilateral rectus sheath block (RSB), which was aimed to prevent postoperative somatic pain on all patients who underwent laparoscopic cholecystectomy (LC). Ultrasound-guided bilateral ESPB at T7 level was performed only to the intervention group to provide the visceral analgesic block. The intraoperative requirement for remifentanil (P = 0.021) and the cumulative fentanyl consumption at postoperative 24-hours was significantly lower in the ESPB group (206.5 ± 82.8 μg vs.283.7 ± 102.4 μg, respectively; P = 0.004) compared to non-ESPB group. The ESPB group consistently showed lower accumulated analgesic consumption compared with those in the non-ESPB group at all observed time-points (all P < 0.05) after 2 hours and the degree of the accumulated analgesic consumption reduction was greater (P = 0.04) during the 24-hour postoperative period. Pain severity was lower in the ESPB group at 6-hours postoperatively. The significantly reduced opioid consumption in ESPB group may imply that while preliminary and in need of confirmation, ESPB has potential visceral analgesic effect. Therefore, performing ESPB solely may be feasible in inducing both somatic and visceral analgesia.

The Effects of Erector Spinae Plane Block in Terms of Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy: A Meta-Analysis of Randomized Controlled Trials

“…The reason for the exclusion was as shown below: case report (n = 1), conference abstract (n = 1). Therefore, a total of 8 RCTs with 442 patients were included in the final analysis ( Figure 1 ) [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ] 199 patients were allocated to the ESPB group, 168 patients were allocated to the control group, and 75 patients were allocated to the oblique subcostal transversus abdominis plane (OSTAP) block group. Some studies have multiple groups [ 19 , 23 ].…”

“…Postoperative cumulative opioid consumption was reported in 7 RCTs, including 333 patients [ 16 , 17 , 19 , 20 , 21 , 22 , 23 ]. For postoperative analgesia, morphine was administered in 2 RCTs [ 16 , 19 ], tramadol was used in 4 RCTs [ 17 , 21 , 22 , 23 ], and fentanyl was used in 1 RCT [ 20 ]. The amounts of tramadol and fentanyl were converted to morphine-equivalent doses for data synthesis and analysis.…”

“…Six RCTs [ 16 , 17 , 19 , 20 , 22 , 23 ], including 252 patients, reported pain severity using a visual analog scale (VAS) or numerical rating scale (NRS) of 0 to 10, at each predefined time point. This meta-analysis demonstrated a significant difference in the 12 h pain scores (MD −0.56, 95% CI −1.04 to −0.07, p = 0.031) ( Figure 4 a), whereas no significant difference in the 24 h pain scores between the two groups was observed (MD −0.25, 95% CI −0.69 to 0.18, p = 0.194) ( Figure 4 b).…”

“…The incidence of PONV was reported in 6 RCTs, including 252 patients [ 16 , 17 , 19 , 20 , 22 , 23 ]. The incidence of PONV was significantly lower in the ESPB group than in the control group (OR 0.36, 95% CI 0.21 to 0.63, p = 0.005) ( Figure 5 ).…”

“…Furthermore, two studies performed additional regional block for postoperative analgesia. Bupivacaine was infiltrated into trocar sites in the control group [ 19 ], or ropivacaine was administered between the rectus sheath and the rectus abdominis muscle in all groups [ 20 ].…”