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

Area of Science:

• Anesthesiology
• Pain Management
• Regional Anesthesia

Background:

• The visceral analgesic efficacy of erector spinae plane block (ESPB) remains debated.
• Laparoscopic cholecystectomy (LC) involves both somatic and visceral pain.
• Effective visceral analgesia is crucial for postoperative recovery.

Purpose of the Study:

• To investigate the visceral analgesic efficacy of ultrasound-guided bilateral ESPB in patients undergoing LC.
• To compare opioid consumption and pain severity between patients receiving ESPB and those not receiving it.
• To assess the potential of ESPB for providing both somatic and visceral analgesia.

Main Methods:

• Randomized controlled trial involving patients undergoing LC.
• All patients received ultrasound-guided bilateral rectus sheath block (RSB) for somatic pain.
• Intervention group received additional ultrasound-guided bilateral ESPB at T7 level.
• Intraoperative remifentanil use and 24-hour cumulative fentanyl consumption were measured.
• Pain severity was assessed at multiple postoperative time points.

Main Results:

• The ESPB group had significantly lower intraoperative remifentanil requirements (P=0.021).
• Cumulative fentanyl consumption at 24 hours was significantly lower in the ESPB group (206.5 ± 82.8 μg vs. 283.7 ± 102.4 μg; P=0.004).
• Lower accumulated analgesic consumption was observed in the ESPB group at all time points after 2 hours (P<0.05), with a greater reduction over 24 hours (P=0.04).
• Pain severity was lower in the ESPB group at 6 hours postoperatively.

Conclusions:

• Significantly reduced opioid consumption suggests a potential visceral analgesic effect of ESPB.
• ESPB may provide both somatic and visceral analgesia, potentially allowing for its sole use.
• Further studies are needed to confirm these preliminary findings.