https://orcid.org/0000-0001-8076-4171
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ABSTRACT
Background
Intrathecal morphine (ITM) has been evidenced to provide efficient analgesia for hepatopancreaticobiliary surgery (HPB) in the postoperative period. Despite its benefits, ITM carries certain risks, such as pruritus, postoperative nausea and vomiting, and of utmost importance, the possibility of delayed respiratory depression. We conducted this study to compare the effectiveness of bilateral erector spinae plane block (ESPB) and ITM for analgesia following major HPB surgery. Our hypothesis was that bilateral ESPB would lead to a significant reduction in opioid consumption within the first 24 hours following surgery, with a lower incidence of side effects.
Methods
Forty patients with scheduled major HPB surgery were randomly allocated to receive either bilateral ESPB (n = 20) or ITM (n = 20) before general anesthesia induction. The primary outcome was cumulative postoperative nalbuphine consumption in the first 24 hours.
Results
Cumulative nalbuphine consumption at 24 hours after surgery was significantly lower in the ITM group compared to ESPB (3.05 ± 0.38 versus 6.56 ± 0.88 respectively). However, the ESPB group demonstrated effective pain control as indicated by pain scores of ≤2 at rest and ≤3 when coughing throughout all measured time points. Moreover, ESPB significantly reduced the incidence of postoperative nausea, vomiting (p = 0.03), and pruritus (p = 0.003) within the first 24 hours postoperatively compared to ITM.
Conclusions
Although bilateral ESPB resulted in higher opioid consumption than ITM in the first 24 hours after major HPB surgery, the adverse effects were less with minimal or no risk of hemodynamic instability.
Abbreviations
| ESPB | = | Erector Spinae Plane Block, |
| ITM | = | Intrathecal Morphine, |
| HPB | = | hepatopancreaticobiliary, |
| BMI | = | Body mass index, |
| ASA | = | American society of anesthesiologists, |
| NRS | = | Numerical Rating Scale, |
| HR | = | heart rate, |
| SBP | = | systolic blood pressure, |
| DBP | = | diastolic blood pressure, |
| MAP | = | mean arterial pressure, |
| PRBCs | = | Packed Red Blood Cells, |
| FFP | = | fresh frozen plasma, |
| UOP | = | Urine Output, |
| TOF | = | Train of four |
| PACU | = | post-anesthesia care unit, |
| TAPB | = | transversus abdominal plane block, |
| PCA | = | patient-controlled analgesia, |
| SPSS | = | Statistical Package for the Social Sciences, |
| CONSORT | = | Consolidated Standards of Reporting Trials. |
Acknowledgments
The authors wish to thank the study participants for their involvement in the study. The authors like to thank the medical staff of the participating clinical service at Assiut University Hospitals, Egypt, for their support with data collection.
Disclosure statement
None of the authors have any personal, professional, or financial conflicts of interest to declare.
Author contributions
Magdy Mohammed Mahdy: Conceptualization, Methodology, Software, Investigation, Writing – Review & Editing.
Mohamed Galal Abdel-Rahim: Validation, Data Curation, Writing - Review & Editing, Supervision.
Mahmoud Talaat Abd_Elhafeez: Software, Formal analysis, Investigation, Writing – Original Draft.
Mostafa Samy Abbas: Validation, Writing – Review & Editing, Supervision.