Cennet TOR KILIÇ, Yavuz GÜRKAN, Alparslan KUŞ, Can AKSU, Hadi Ufuk YÖRÜKOĞLU

Erektor Spina Plan Bloğunun Laparoskopik Kolesistektomi Sonrası Postoperatif Ağrı Üzerine Etkisi: Randomize Kontrollü Çalışma

Amaç: Erektör spina plan (ESP) bloğu, postoperatif ağrı yönetimi için yeni bir tekniktir. Bu çalışmanın ilk amacı, ultrason eşliğinde uygulanan ESP’nin, laparoskopik kolesistektomide postoperatif analjezi sağlamak açısından etkinliğini değerlendirmektir. Yöntem: Elektif laparoskopik kolesistektomi operasyonu planlanan 20-70 yaşında 46 ASA I-II hasta çalışmaya dahil edildi. Hastalar ESP ve Kontrol grubu olmak üzere 2 gruba randomize edildi. ESP grubundaki hastalara 20 ml %0.25 bupivakain ile ultrason eşliğinde ESP bloğu yapıldı. Her iki gruptaki hastalara operasyon sonrası morfin içeren hasta kontrollü analjezi cihazı temin edildi. Hastaların postoperatif 24. saatteki morfin tüketimleri ve postoperatif numerik ağrı skalaları (NRS) kaydedildi. Bulgular: Postoperatif 24. saatte ESP grubunda ortalama morfin tüketimi 7.5±5.8 mg iken kontrol grubunda 13.2±5.6 mg (p

The Effect of Erector Spinae Plane Block on Postoperative Pain Following Laparoscopic Cholecystectomy: A Randomized Controlled Study

Objective: Erector spinae plane block (ESP) is a novel technique for postoperative pain management. Primary aim of this study is to evaluate efficacy of ultrasound -guided ESP for providingpostoperative analgesia in laparoscopic cholecystectomy (LC) procedures.Methods: Forty-six ASA I-II patients aged 20-70, who were scheduled to undergo elective LC wereincluded in the study. Patients were randomized into two groups as ESP and Control group.Patients in the ESP group received ultrasound (US)- guided ESP block with 20 ml 0.25% bupivacaine. An intravenous patient-controlled analgesia device containing morphine was provided forall the patients in both groups. Morphine consumptions at postoperative 24th hour and postoperative numeric rating scale (NRS) scores for pain were recorded.Results: Mean morphine consumptions at postoperative 24th hour were 7.5 mg±5.8 in the ESPgroup while it was 13.2±5.6 mg in the control group (p

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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
Aksu C, Gürkan Y. Ultrasound guided erector spinae block for postoperative analgesia in pediatric nephrectomy surgeries. J Clin Anesth. 2018;45:35-6. https://doi.org/10.1016/j.jclinane.2017.12.021
Cesur S, Ay AN, Yayik M, Naldan ME, Gurkan Y. Ultrasound-guided erector spine plane block provides effective perioperative analgesia and anaesthesia for thoracic mass excision: A report of two cases. Anaesth Crit Care Pain Med. 2018;52352-5568:30372-7. https://doi.org/10.1016/j.accpm.2018.01.002. [E-pub ahead of print]
Tulgar S, Kapakli MS, Şentürk 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
Aksu C, Gürkan Y. Ultrasound-guided bilateral erector spinae block could provide effective postoperative analgesia in laparoscopic cholecystectomy in paediatric patients. Anaesth Crit Care Pain Med. 2019;38:87-8. https://doi.org/10.1016/j.accpm.2018.03.008. [Epub ahead of print]
Hannig KE, Jessen C, Soni UK, Børglum J, Bendtsen TF. Erector Spinae Plane Block for Elective Laparoscopic Cholecystectomy in the Ambulatory Surgical Setting. Case Rep Anesthesiol 2018;2018:5492527. https://doi.org/10.1155/2018/5492527
Barazanchi AWH, MacFater WS, Rahiri JL, Tutone S, Hill AG, Joshi GP; PROSPECT collaboration. 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
Ahiskalioglu EO, Ahiskalioglu A, Aydin P, Yayik AM, Temiz A. Effects of single-dose preemptive intravenous ibuprofen on postoperative opioid consumption and acute pain after laparoscopic cholecystectomy. Medicine. 2017;96:8. https://doi.org/10.1097/MD.0000000000006200
Puolakka P, Puura A, Pirhonen R et al. Lack of analgesic effect of parecoxib following laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 2006;50:1027-32. https://doi.org/10.1111/j.1399-6576.2006.01116.x
Liu YY, Yeh CN, Lee HL, et al. Local anesthesia with ropivacaine for patients undergoing laparoscopic cholecystectomy. World J Gastroenterol. 2009;15:2376. https://doi.org/10.3748/wjg.15.2376
Hilvering B, Draaisma W, Van der Bilt J, Valk R, Kofman K, Consten E. Randomized clinical trial of combined preincisional infiltration and intraperitoneal instillation of levobupivacaine for postoperative pain after laparoscopic cholecystectomy. Br J Surg. 2011;98:784-9. https://doi.org/10.1002/bjs.7435
Gurusamy KS, Nagendran M, Guerrini GP, Toon CD, Zinnuroglu M, Davidson BR. Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2014;13:CD007337. https://doi.org/10.1002/14651858.CD007337.pub3
Ross SB, Mangar D, Karlnoski R, et al. Laparo-endoscopic single-site (LESS) cholecystectomy with epidural vs. general anesthesia. Surg Endosc. 2013;27:1810-9. https://doi.org/10.1007/s00464-012-2667-8
Naja MZ, Ziade MF, Lönnqvist PA. General anesthesia combined with bilateral paravertebral blockade (T5-6) vs. general anesthesia for laparoscopic cholecystectomy: a prospective, randomized clinical trial. Eur J Anaesthesiol. 2004;2:489-95.
Naja ZM, El-Rajab M, Ziade F, Al-Tannir M, Itani T. Preoperative vs. postoperative bilateral paravertebral blocks for laparoscopic cholecystectomy: a prospective randomized clinical trial. Pain Pract. 2011;11:509-15. https://doi.org/10.1111/j.1533-2500.2011.00447.x
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
Chin, KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia. 2017;72:452-60. https://doi.org/10.1111/anae.13814
Adhikary SD, Bernard S, Lopez H, Chin KJ. Erector spinae plane block versus retrolaminar block: A magnetic resonance imaging and anatomical study. Reg Anesth Pain Med. 2018;43:756-62. https://doi.org/10.1097/AAP.0000000000000798
Bonvinci D, Tagliapietra L, Giacomazzi A, Pizzirani E. Bilateral ultrasound-guided erector spinae plane blocks in breast cancer and reconstruction surgery. J Clin Anesth. 2017;44:13-4.
Chin KJ, Malhas L, Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery: a report of 3 cases. Reg Anesth Pain Med. 2017;42:372-6. https://doi.org/10.1097/AAP.0000000000000581
Donatsky AM, Bjerrum F, Gögenur I. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surg Endosc. 2013;27:2275-82. https://doi.org/10.1007/s00464-012-2759-5