Ultrasound Guided Bilateral Erector Spinae Plane Block in Laparoscopic Cholecystectomy
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      This study will define the postoperative analgesic effect of ESP block via amount of
      patient-controlled analgesia (PCA) and postoperative analgesic consumption (such as routinely
      and rescue analgesics) and compare the control group in patients having laparoscopic
      Cholecystectomy .
    

Detailed description: 
      Laparoscopic interventions are considered as minimally invasive procedures. They have both
      cosmetic and open surgery advantages in terms of surgical stress. Laparoscopic
      cholecystectomy is the most commonly performed laparoscopic upper abdominal procedure. After
      this procedure, patients often complain of excessive pain. Non-steroidal anti-inflammatory
      agents and opioids are used for postoperative analgesia. In addition, in the past decade, in
      the guideline of ultrasonography, peripheral block types with analgesic activity have been
      described in laparoscopic cholecystectomies as well as in many operations on the development
      of regional anesthesia and analgesia techniques. It was reported that transverse abdominis
      plane (TAP) block provided effective analgesia in these cases in the first ultrasonography
      guideline of petit triangle region in 2010. Later studies on TAP block activity, drug doses
      and concentrations in laparoscopic cholecystectomies have been conducted. There are also
      publications indicating that TAP block has been applied to the subcostal region for more
      effective analgesia. The ESP block is a new block for the treatment of thoracic neuropathic
      pain. In the following process; ESP block thoracic and breast surgery, bariatric surgery, and
      upper abdominal surgeons have also been reported to provide effective postoperative analgesia
      .

      The standard practice for post-operative pain management for laparoscopic cholecystectomy in
      Maltepe University Hospital consists of routine intravenous analgesic and rescue analgesics
      and in combination with patient-controlled analgesia (PCA).

      Given the importance of providing adequate analgesia in upper abdomen surgery and lack of
      consensus amongst surgeons and anesthesiologists for the optimal analgesic technique, the
      investigators are proposing a prospective observational study to examine the analgesic
      efficacy of the ESP block in laparoscopic cholecystectomy as a potential analgesic technique.
      The investigators are hoping the results of this study will provide framework for future
      larger comparative studies.
    

Intervention name(s): Ultrasound guided erector spinae plane block; Standard Pain Followup and Monitorization
Intervention type(s): Procedure; Other
Intervention description(s): A high-frequency linear ultrasound transducer will be placed in a longitudinal parasagittal orientation 3 cm lateral to T9 spinous process. The erector spinae muscles will be identified superficial to the tip of T9 transverse process. The patient's skin will be anesthetized with 2% lidocaine. A 17-gauge 8-cm needle will be inserted using an in-plane superior-to-inferior approach to place the tip into the fascial plane on the deep (anterior) aspect of erector spinae muscle. The location of the needle tip will be confirmed by visible fluid spread lifting erector spinae muscle off the bony shadow of the transverse process. A total of 30 mL of 0.375% bupivacaine will be injected (maximum of 3mg/kg).; Numeric Rating Scale (NRS) pain score will be recorded from 20th minute in recovery room followed by 1.-3.-6.-12.-18.-24.hours. Intravenous meperidine administration at 0.5 mg / kg rescue analgesia was determined in patients with a NSR score of 6 and over in the postoperative collection room. It is planned that the patient will continue to follow the hourly NRS score in ward. Intramuscular diclofenac will be administered in this period if NRS 6 and if it is over, intravenous 0.5 mg / kg meperidine will be administered if NRS score is 6 or more after 2 hours. Salvage analgesic needs and times will be noted in detail, and the use of rescue analgesics, as well as NRS scores at designated hours, will be kept in a statistical evaluation.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Controlled randomised blinded preospective study
Masking: Single (Care Provider)
Primary purpose: Treatment