الفهرس | Only 14 pages are availabe for public view |
Abstract Laparoscopic cholecystectomy (LC) is the most common intraabdominal surgical procedure globally. Despite improvements in anesthesia and surgery, postoperative pain is still a crucial problem after LC. Perioperative pain management goals are to alleviate suffering, obtain early mobilization and rapid discharge, and improve patient satisfaction. While there are now many regional anesthetic techniques for use in thoracic and abdominal procedures, very few of these techniques are appropriate for postoperative analgesia in laparoscopic cholecystectomy (LC). LC leads to somatic pain from the supraumbilical abdominal area and visceral pain due to pneumoperitoneum and surgical manipulation. Ultrasound-Guided Erector Spinae Plane block (US-ESP), described by Forero et al. in 2016 has gained popularity. This new regional technique provides analgesia via its effects on the ventral rami and dorsal rami of the spinal nerves, depending on the level of the injection site. As the erector spinae fascia extends between the nuchal fascia cranially and sacrum caudally, the injected local anesthetic agent spreads over several levels. The External oblique intercostal plane (EOI) block is a recently described technique for upper midline and lateral abdominal wall analgesia. Elsharkawy et al. demonstrated the potential mechanism of this technique with a cadaveric study reporting consistent staining of both lateral and anterior branches of intercostal nerves T7-T10. So, this study aimed to evaluate the analgesic effect of bilateral erector spinae plane block versus bilateral external oblique intercostal plane block in patients undergoing Laparoscopic Cholecystectomy. To elucidate our aim a prospective randomized double-blind study conducted on 93 of patients were randomized into three groups using a closed envelope technique in sequentially numbered opaque envelopes that was opened by an anesthesiologist not involved in the study. This study was conducted in National Liver Institute, Menoufia University during the period time from April 2023 to December 2023. All patients were subjected to the following preoperative surveillance included hematological screening (hematocrit level, serum electrolytes, and blood grouping), biochemical liver and renal tests, standard coagulation studies e.g., prothrombin time-international normalized ratio (PT-INR). In addition, electrocardiography and chest Xray were ordered if indicated. Intraoperative management, premedication, general anesthesia induction, and maintenance were the same for all patients. Standard monitoring procedures include pulse oximetry, electrocardiography, and noninvasive arterial pressure prior to anesthetic induction. Postoperative measurements include time for the first request for rescue analgesia (when NRS is 4 or more), Numerical Rating Scale (NRS score) and hemodynamics: (HR and MAP). |