Comparison of Ultrasound-Guided Erector Spinae Plane Block and Oblique Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia After Laparoscopic Cholecystectomies: A Prospective Randomized Controlled Trial.

Introduction Laparoscopic cholecystectomy (LC) is a commonly performed minimally invasive surgical procedure that can result in significant postoperative discomfort. Pain following this surgery has both somatic and visceral components. Providing adequate pain relief after the procedure is essential to enable early ambulation, which is crucial for patient satisfaction and facilitating timely discharge. The application of ultrasound (US) in anesthetic practice has initiated a new era of US-guided blocks for postoperative analgesia, replacing traditional methods. This study was planned to evaluate the analgesic efficacy of US-guided erector spinae plane block (ESPB) and oblique subcostal transversus abdominis plane (OSTAP) block in patients undergoing elective LC, to compare the analgesic requirements in both groups, and to compare the numeric rating scale (NRS) scores in both groups. Materials and methods Sixty patients aged between 18 and 75 years, with American Society of Anesthesiology (ASA) Grades I and II, were enrolled in the study. They were randomized into two groups: one group that received a bilateral ESPB (Group E) at the T7 level and another that received a bilateral OSTAP block (Group O) with 20 mL of 0.375% bupivacaine, following intubation. The primary outcomes measured were the median NRS scores and the time to first analgesic requirement during the first 24 hours postoperatively. Secondary outcomes included total tramadol consumption, analgesic requirements, and complications related to the opioids or blocks. Results The ESPB group reported an NRS score < 4 up to 12 hours postoperatively. The NRS scores in Group E were significantly lower at 20 minutes, 40 minutes, 1 hour, 3 hours, 6 hours, and 12 hours post-surgery when compared to Group O (p < 0.05). The mean time to first rescue analgesic requirement was 12.2 ± 5.6 hours in Group E and 6.6 ± 2.84 hours in Group O, which was found to be statistically significant (p < 0.001). The total tramadol consumption per patient in 24 hours was significantly higher in Group O than in Group E (p < 0.001). Conclusion Bilateral US-guided ESPB provides effective analgesia, resulting in lower pain scores and reduced postoperative tramadol consumption within the first 12 hours for patients undergoing LC.