Application Of Ultrasound-guided Erector Spinae Plane Block In Laparoscopic Cholecystectomy

Purpose: Laparoscopic cholecystectomy has become the "gold standard" for clinical treatment of benign gallbladder diseases such as gallbladder stones after more than 30 years of development in my country,due to its mild trauma,low stress response,short operation time,and low probability of complications.Ultrasound-guided erector spinae plane block(ESPB)is a novel fascial space block technique,which has the advantages of easy and safe procedure,reliable analgesia,and fewer complications.This study will be based on the concept of ERAS to explore the effectiveness and safety of general anesthesia combined with ESPB in laparoscopic cholecystectomy.Methods: This study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Anhui Medical University.We adopted a randomized,controlled,non-double-blind design.Sixty adult patients undergoing elective laparoscopic cholecystectomy in our hospital from 2019 January to Junewere selected,and were randomly divided into general anesthesia combined with erector spinae plane block group(N group)or simple general anesthesia group(C group).The incisional,viscera and referred(shoulder)pain were recorded respectively at 1h,2h,4h,8h,12 h,16h,24 h after surgery using visual analogue scoring method(0 points for painless and 10 points for severe pain).The hemodynamic data at induction of anesthesia(T0),immediately after the operation of the skin(T1),at the time of pneumoperitoneum(T2),during the operation,20 minutes after the start of the operation(T3),after the end of the pneumoperitoneum(T4),transfer into PACU immediately(T5)and transfer out from PACU(T6).Intraoperative operation time,pneumoperitoneum time,total amount of anesthetics used,eye opening and extubation time were recorded.Postoperative evacuation time,the time of getting out of bed,postoperative hospital stay,and postoperative nausea and vomiting were recorded.Results: There was no significant difference between the two groups of patients in terms of operation time,intraoperative pneumoperitoneum time,eye opening time and extubation time(P>0.05).The comparison of postoperative pain scores between the two groups showed that the postoperative visceral pain scores of N group were lower than those of the C group at all time points after surgery(P<0.05);The referred(shoulder)pain scores of patients in N group were lower than those in C group at 12 h,16h and 24 h after surgery(P<0.05);The postoperative skin incision pain scores of patients N group were lower than those in the C group at all time points after surgery(P<0.05).The intraoperative systolic blood pressure of patients in N group was lower than that in the C group at T2,T4 and T6(P<0.05).The intraoperative consumption of sufentanil,remifentanil and postoperative rescue analgesia sufentanil in N group were lower than those in the C group(P<0.05).The incidence of postoperative nausea and vomiting in N group was lower than that in the C group(P<0.05).Conclusion: General anesthesia combined with erector spinae block anesthesia for laparoscopic cholecystectomy can improve postoperative analgesia,reduce the consumption of anesthetics,maintain intraoperative circulation stability,and facilitate postoperative recovery of the body.