腹腔鏡下腎摘出術における術後鎮痛のための超音波ガイド下連続腸骨筋膜面ブロックと硬膜外ブロックの比較：前向き介入研究

Postoperative pain persists after nephrectomy, despite advances in laparoscopic techniques. A traditional epidural is associated with risks, prompting exploration of alternatives, such as the erector spine plane block (ESPB). This study compares the analgesic efficacy of ultrasound-guided continuous ESPB versus epidural block in patients undergoing laparoscopic nephrectomy.

This prospective, randomized controlled study included 60 patients, aged 18-65, with American Society of Anesthesiologists physical status I-II, undergoing elective laparoscopic nephrectomy. Exclusion criteria included refusal to provide informed consent, local infection, coagulopathies, cardiovascular, respiratory disorders, and chronic opioid use. Patients were randomly assigned to either Group I (ESPB) or Group II (epidural block). Standard monitoring and anesthesia protocols were followed, with a continuous infusion of levobupivacaine plus fentanyl administered postoperatively for 24 h in both groups. The primary outcome measured was time to first rescue analgesia, with secondary outcomes including pain scores, analgesic consumption, and perioperative complications.

The study found that Group I had a longer time to first rescue analgesia (9.50 h) compared to Group II (4.67 h), although the difference was not statistically significant. The cumulative dose of rescue analgesics was lower in Group I (100 mg) than in Group II (166.33 mg), with no significant difference (P = 0.219). Visual Analog Scale scores, hemodynamic changes, intraoperative fentanyl consumption, bowel recovery, and ambulation times were comparable.

ESPB is a suitable and better alternative to epidural block for postoperative analgesia in laparoscopic nephrectomy, in the context of ease administration and unilateral block.