Bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled study

Abstract Introduction Laparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al., the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations. Materials and methods This study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologists (ASA) physical status I-II, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups. Results There was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6th hour (p = 0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p = 0.044 and p = 0.022, respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p = 0.011). Discussion In conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.

Descritores de dor pós-hemorroidectomia / Post-hemorrhoidectomy pain descriptors

Estudo conduzido com o objetivo de comparar as escalas derivadas de julgamentos de diferenças e verificar a estabilidade e a concordância das estimativas da atribuição dos descritores à dor pós-operatória julgadas por três diferentes amostras. Participaram do estudo 19 sujeitos submetidos a hemorroidectomia, os quais foram divididos aleatoriamente em três grupos (Grupo C, T e F), que receberam via endovenosa cetoprofeno 100 mg, tenoxicam 40 mg ou soro fisiológico 0,9 por cento, antes do início da cirurgia. A tarefa de cada participante foi assinalar um escore, de 1 a 7, a cada descritor de dor sentida na primeira queixa após a cirurgia. Os descritores atribuídos à dor pós-operatória foram avaliados pelo método psicofísico de estimação de categorias. Os resultados obtidos foram: os descritores de maior atribuição para o Grupo C foram intensa, insuportável e terrível; para o Grupo T, foram intensa, tremenda e insuportável e para o Grupo F, foram insuportável, intensa e terrível