Bilateral continuous erector spinae plane block using a programmed intermittent bolus regimen versus intrathecal morphine for postoperative analgesia in living donor laparoscopic hepatectomy: A randomized controlled trial.

Abstract

STUDY OBJECTIVE\nTo determine if continuous bilateral erector spinae plane (ESP) blocks would improve the postoperative analgesia in the first 48\xa0h after laparoscopic donor hepatectomy, compared to intrathecal morphine (ITM).\n\n\nDESIGN\nProspective, randomized controlled trial.\n\n\nSETTING\nA single tertiary care center from October 2019 and September 2020.\n\n\nPATIENTS\nA total of 60 donors scheduled to undergo elective laparoscopic right hepatectomy.\n\n\nINTERVENTIONS\nSixty donors were randomized to receive either bilateral continuous T8 ESP blocks with a programmed intermittent bolus regimen of 10\xa0mL 0.2% ropivacaine every 3\xa0h for 48\xa0h (n\xa0=\xa030) or 400\xa0μg ITM (n\xa0=\xa030), in addition to IV fentanyl PCA and multimodal analgesia.\n\n\nMEASUREMENTS\nThe primary outcome was cumulative opioid consumption over the first 48\xa0h, expressed as IV morphine equivalents. Secondary outcomes included pain scores, Quality of Recovery-15 scores, ambulation within 24\xa0h, time to first flatus, and opioid-related adverse drug events over 72\xa0h.\n\n\nMAIN RESULTS\nFifty-nine donors were analyzed. Cumulative 48-h opioid consumption was similar between the ITM and ESP groups (29.8\xa0±\xa018.2 vs. 35.1\xa0±\xa021.9\xa0mg, mean difference (ESP-ITM) (95% CI), 5.3 (-11.5 to 22) mg; p\xa0>\xa00.99). Resting pain scores at 48 and 72\xa0h postoperatively were significantly lower in the ESP group (0 [0-2] vs. 3 [1.5-3], and 0 [0-2] vs. 3 [1-3] respectively, both p<0.001) (Goldaracena and Barbas, 2019; Ko et al., 2009; Choi et al., 2007 [1-3]) respectively, both p\xa0<\xa00.001). The ESP group had significantly lower incidences of postoperative nausea, vomiting, and pruritus at all timepoints. There were no differences in recovery outcomes.\n\n\nCONCLUSIONS\nContinuous ESP blocks did not reduce cumulative 48-h opioid consumption compared to 400\xa0μg ITM after laparoscopic donor hepatectomy, but it was associated with a significantly reduced risk of postoperative nausea, vomiting and pruritus.\n\n\nCLINICAL TRIAL NUMBER AND REGISTRY URL\nClinical Trial Registry of Korea; https://cris.nih.go.kr/cris/index.jsp and identifier: KCT0004313; date of registration: October 15, 2019; principal investigator s name: Justin Sangwook Ko.