Effectiveness of Ultrasound Guided Erector Spinae Plane Block (ESB) in Laparoscopic Cholecystectomy: A Randomised Controlled Trial

Background: In Hong Kong, 6% of Laparoscopic Cholecystectomies (LC) were performed as day cases in public hospitals in 2022. Before the start of the day surgery facility in the New Territories West Cluster (NTWC), a randomised controlled trial (RCT) was initiated to assess whether ESB was indicated to improve pain relief and facilitate discharge.
Methods: This was a prospective, double-blind study, in which 68 patients were recruited and randomised into 2 groups. The ESBLA group had the right ESB with 20 ml of 0.25% plain bupivacaine, and the ESBNS had the right ESB with 20 ml of normal saline. Multimodal analgesia was administered intraoperatively in both groups. Rescue intravenous (IV) fentanyl was used to keep the pain score of 4 or less on a 0 to 10 numerical rating scale (NRS) in the post-anesthesia care unit (PACU). Worst pain score and the use of analgesics were monitored in PACU and on the ward on postoperative day 0 (D0) and day 1 (D1).
Results: The proportion of patients with moderate to severe pain on D0 in the ward was significantly less in ESBLA as compared to ESBNS (9.1% vs 32.3%, p=0.02, chi-square test). The worst pain score during performing ESB was 0, IQR (0 to 1). There was no difference in the PCA opioid consumption and length of stay (LOS) between the 2 groups.
Conclusion: ESB significantly reduced moderate to severe pain on D0 in the ward. There was no significant difference in worst pain score in PACU and on D1 in the ward between the two groups. Since ESB was easy to perform with an ultrasound machine, with no complications noted in this study, it is recommended for postoperative pain relief for laparoscopic cholecystectomies.