Does Erector Spinal Block Improve Quality of Recovery After Laparoscopic Cholecystectomy
Condition: Postoperative Recovery
Study type: Interventional

Summary: 
      The primary aim of this prospective, randomized study is to evaluate the effect of erector
      spinae block (ESP) on quality of recovery with the QoR-40 questionnaire in patients
      undergoing elective laparoscopic cholecystectomy.
    

Detailed description: 
      Laparoscopic cholecystectomy, one of the most common general surgical procedures, is the gold
      standard for the treatment of symptomatic gallbladder diseases. Although it is considered as
      minimally invasive surgery, pain in the early postoperative period is still meaningful.
      Proper pain control is essential for optimizing clinical outcomes and earlier ambulation
      after surgery. Traditional pain management with opioids provide good pain control, however,
      have undesirable side effects such as nausea, vomiting, and respiratory depression.
      Multimodal analgesia strategies with different classes of analgesics or local anesthetics may
      enhance pain relief and reduce side effects after surgery. The ESP a newer regional nerve
      blockade, has been used as part of a multimodal strategy to optimize postoperative pain
      control. The primary aim of this study is to evaluate the effect of ESP block on
      postoperative recovery quality in patients undergoing laparoscopic cholecystectomy with
      QoR-40 recovery questionnaire. Secondary aim is to assess the effect of ESP block on
      postoperative pain, nausea, and vomiting.

      Study hypothesize is that patients who receive an ESP block in addition to the current
      standard of care, consisting of parenteral opioids and paracetamol, will have a clinically
      significant improvement in their QoR-40 at postoperative day 1 and lower pain levels, as
      measured by NRS in comparison to those patients who receive the current standard of care
      along.
    

Intervention name(s): local anesthetic injection; Standard perioperative and postoperative analgesia protocol.
Intervention type(s): Other; Other
Intervention description(s): A linear ultrasound transducer will be place in a longitudinal parasagittal orientation about 3 cm lateral to spinous process. Local anesthetic mixture will be injected bilaterally into the fascial plane on the deep aspect of erector spinae muscle. Standard perioperative and postoperative analgesia protocol will be given and postoperative pain levels will be determined by Numerical rating scale (NRS).; Standard perioperative and postoperative analgesia protocol will be given consisting of paracetamol 1 gr IV and tenoxicam 20 mg IV initiated after induction of anesthesia. At the end of the operation patients will receive contramal 1 mg/kg IV before extubation. Postoperative pain levels will be determined by Numeric Rating Scale (NRS) system, 20 minutes intervals in the first hour and at 2th, 6th, 12th and 24 th hour. For the first hour in the postoperative care unit, tramadol 50 mg IV will be given for rescue analgesia with minimum 20 minutes between doses, in patients showing a NRS ≥ 4. Paracetamol 1 g / 12 hour will be given during ward follow-up. In the ward in patients showing a NRS ≥ 4 tramadol 50 mg IV will be given for analgesia.
Intervention MeSH terms: Anesthetics; Anesthetics, Local
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Other