A Randomized Prospective Double-Blind Comparative Study to Assess the Analgesic Efficacy of Ultrasound-Guided Erector Spinae Plane Block Versus Port-Site Infiltration in Laparoscopic Cholecystectomy

Background: Laparoscopic cholecystectomy (LC) is a commonly performed minimally invasive surgery that frequently leads to post-operative pain. Ultrasound (US)-guided bilateral erector spinae plane block (ESPB) is a relatively safe technique that has good analgesic effects for various surgeries. This study aimed to compare the analgesic efficacy of US-guided ESPB with port-site infiltration in patients undergoing elective laparoscopic cholecystectomy. 
Methods: Sixty patients undergoing elective LC were recruited and randomized into two groups. Group ES received bilateral US-guided ESPB with 20 ml 0.375% ropivacaine at each side and port-site infiltration with 20 ml 0.9% normal saline (NS). Group PS received port-site infiltration with 20 ml 0.375% ropivacaine and bilateral US-guided ESPB with 20 ml 0.9% NS on each side. The primary outcome was the time to first request of analgesia, whereas total dose of intraoperative rescue fentanyl requirement, total doses of rescue analgesics required post-operatively in 24h, visual analogue scale (VAS) scores up to 24 h and time to mobilization were the secondary outcomes.
Results: The mean time to first request of analgesia was prolonged in Group ES (8.87 ± 3.27 hours) than in Group PS (2.63 ± 1.85 hours); (P < 0.001). Additionally, patients in group PS required more intraoperative fentanyl, needed more rescue analgesia post-operatively and had higher VAS scores at rest during 24 hours.
Conclusion: US-guided bilateral ESPB provides better post-operative analgesia than port-site infiltration after LC surgery. Moreover, ESPB increases the mean time to first rescue analgesia, reduces pain scores and total opioid consumption.