Bilateral Erector Spinae Plane Block With 0.375% Ropivacaine and Postoperative Analgesia After Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Cohort Study

Postoperative pain after laparoscopic cholecystectomy may delay recovery and increase opioid exposure. The erector spinae plane block has been proposed as a component of multimodal analgesia, but local prospective data remain limited.

This prospective, randomized, controlled cohort study included 40 adults undergoing elective laparoscopic cholecystectomy. Of these, 20 participants received an ultrasound-guided bilateral erector spinae plane block at T9 with 0.375% ropivacaine (20 mL per side) plus multimodal analgesia, and the remaining 20 patients received multimodal analgesia without the block. The prespecified primary endpoint was resting Numeric Rating Scale pain at 12 hours. Secondary outcomes included pain at additional time points and recorded rescue tramadol use. Analyses were unadjusted and included repeated-measures models, Holm-adjusted pointwise comparisons, standardized mean differences, and Fisher exact tests.

At 12 hours, mean resting pain was 1.80 ± 0.70 in the block group and 3.40 ± 1.31 in the comparison group (mean difference -1.60; 95% CI -2.28 to -0.92; p<0.001; Hedges' g=-1.49). The difference did not reach the prespecified two-point threshold used for sample size planning. Recorded rescue tramadol use occurred in two (10.0%) participants in the block group versus 14 (70.0%) participants in the comparison group (risk ratio 0.143; 95% CI 0.037-0.549; absolute risk difference -0.60; p=0.00024). The group-by-time interaction was not significant for resting or movement pain. Postoperative nausea and vomiting occurred in one participant per group.

Bilateral erector spinae plane block was associated with lower unadjusted pain scores and a marked reduction in recorded rescue tramadol use. The most clinically salient signal was the lower frequency of recorded rescue analgesia, although the indication for every administration could not be independently verified. Because the primary pain difference remained below the prespecified two-point threshold, the findings should be considered hypothesis-generating.