Ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic liver resection: A prospective, randomised controlled, patient and observer-blinded study

BACKGROUNDErector spinae plane block (ESPB) has been reported to manage postoperative pain effectively after various types of surgery. However, there has been a lack of study on the effect of ESPB after liver resection.OBJECTIVESTo investigate the analgesic effects of ESPB on pain control after laparoscopic liver resection compared with conventional pain management.DESIGNProspective, randomised controlled study.SETTINGA single tertiary care centre from February 2019 to February 2020.PATIENTSA total of 70 patients scheduled to undergo laparoscopic liver resection.INTERVENTIONSIn the control group (n = 35), no procedure was performed. In the ESPB group (n = 35), ESPB was performed after induction of general anaesthesia. A total of 40 ml of ropivacaine 0.5% was injected at the T9 level bilaterally. After surgery, intravenous fentanyl patient-controlled analgesia was initiated. Fentanyl and hydromorphone were administered as rescue analgesics.MAIN OUTCOME MEASURESThe primary outcome was the cumulative postoperative opioid consumption at 24 h (morphine equivalent). The secondary outcomes were rescue opioid (fentanyl) dose in the postanaesthesia care unit (PACU) and pain severity at 1, 6, 12, 24, 48 and 72 h, assessed using a numerical rating scale (NRS) score.RESULTSThe median [IQR] postoperative opioid consumption during 24 hours following surgery was 48.2 [17.1] mg in the control group and 45.5 [35.8] mg in the ESPB group (median difference, 4.2 mg; 95% CI, -4.2 to 13.3 mg; P = 0.259). Conversely, rescue opioid in PACU was 5.3 [5.0] mg in the control group and 3.0 [1.5] mg in the ESPB group (median difference, 2.5 mg; 95% CI, 1.0 to 5.0 mg; P < 0.001). There was no significant difference in NRS scores point between the groups at any time.CONCLUSIONESPB does not provide analgesic effect within 24 h after laparoscopic liver resection.TRIAL REGISTRATIONClinical Trial Registry of Korea (https://cris.nih.go.kr.), identifier: KCT0003549).