Ultrasound-guided erector spinae plane block in radical cystectomy: a randomized controlled study | [Anaesthesia, Pain and Intensive Care • 2024]

Author(s):

1. Ahmed Mansour Ahmed: Department of Anesthesia, Pain Relief & ICU, Naotinal Cancer Institute, Cairo University,Cairo,Egypt

2. Algohary Moussa Tantawy: Department of Anesthesia, Pain Relief & ICU, Naotinal Cancer Institute, Cairo University,Cairo,Egypt

3. Essam Mahran: Department of Anesthesia, Pain Relief & ICU, Naotinal Cancer Institute, Cairo University,Cairo,Egypt

4. Tarek Ezzat Abd El Galil: Department of Anesthesia, Pain Relief & ICU, Naotinal Cancer Institute, Cairo University,Cairo, Egyp t,

5. Ahmed Salah Abd El Galil: Department of Anesthesia, Pain Relief & ICU, Naotinal Cancer Institute, Cairo University,Cairo,Egypt

Abstract:

Background & Objectives: Radical cystectomy (RC) is usually performed under general anesthesia, with the management of postoperative pain being a big challenge. Various approaches have been tried, including epidural analgesia, or regional nerve blocks in addiotin to the intravenous patient -controlled analgesia (IV-PCA). We compared the eficacy and safety of bilateral single-injecotin erector spin ae plane block (ESPB) with IV-PCA administered morphine to manage postoperative pain following RC. Methodology: This prospective randomi zed controlled clinical study was performed on 60 participants ranging in age from 21 to 65 years, both sexes, BMI 20-40 kg/m2, ASA physical status II-III, planned for elecvtie RC. Participants were randomized into two equal groups. Group ESPB received ultrasound-guided single shot ESPB at T10 with 20 mL bupivacaine 0.25% bilaterally; IV morphine 3 mg bolus was used as rescue analgesia when the Numeric Rating Scale (NRS) pain score was = 4. Group C (control group) received IV-PCA by morphine 3 mg IV when NRS pain score was = 4 and repeated 1/2 mg if still pain score was recorded = 4 for 15 min. Pain was measured on NRS at 2 , 4 , 8, and 12 h as well as the postoperative heart rate (HR) and mean arterial blood pressure (MAP). Complications were noted, Results: Time to first analgesic request was substantially prolonged in Group ESPB compared to Group C (P < 0.001). Total postoperative consumption of morphine in 1 st 48 h and postoperative nausea and vomintig were substantially reduced in Group ESPB compared to Group C (P < 0.05). NRS pain scores, postoperative HR and MAP measurements were substantially reduced at 2, 4, 8, and 12 h in Group ESPB than Group C (P < 0.05). Bradycardia and hypotension varied insignificantly diefrent between both groups. Respiratory depression and urinary retention did not occur in any patient in both groups. Conclusions: Compared with IV-PCA administered morphine, bilateral single-injecotin ESPB was associated with beetr hemodynamics and analgesic properties , as observed by lower pain scores, less postoperative opioid consumption, and longer time to first analgesic requ est with good safety profile aeftr radical cystectomy.

Page(s): 939-944

DOI: 10.35975/apic.v28i5.2568

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 28, Issue: 5, Year: 2024

Keywords:

Ultrasound , Radical cystectomy , Erector spinae plane block , Patient Controlled Analgesia

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