Publication:

Comparison of thoracic epidural analgesia and ultrasound guided erector spinae plane block for post operative pain control following laparoscopic cholecystectomy: a randomized clinical trial

Background Effective management of postoperative pain is a cornerstone of modern perioperative care, critically influencing patient recovery and overall outcomes. Over the past several decades, significant advancements in regional anesthesia techniques have transformed the landscape of perioperative analgesia.

Methods The study groups were divided into two, named group A and group B. The total sample size was 80 (40 patients in each group). In Group A, Thoracic epidural analgesia was given at T8-T9 epidural space via paramedian approach using 7.5ml of 0.75% Ropivacaine diluted with 7.5ml of Normal saline and 7.5mcg Dexmedetomidine, and in the Group B, Erector spinae plane block was given bilaterally at T9 transverse process level using 7.5ml of 0.75% Ropivacaine diluted with 22.5ml of Normal saline and 7.5mcg of Dexmedetomidine.

Results Duration of analgesia was more in the Thoracic Epidural Analgesia (TEA) group with 894±115.93 mins. There was no significant difference in the dosage of rescue analgesic, however the TEA group needed lesser rescue dosages than those in ESPB group. Pain scores were similar across both groups at all time intervals. Hemodynamic parameters varied early on, with TEA maintaining higher heart rates and MAP values initially. Side effects were comparable between the groups.

Conclusions This randomized clinical trial comparing Thoracic Epidural Analgesia (TEA) and Ultrasound-Guided Erector Spinae Plane Block (ESPB) for post-operative pain control following laparoscopic cholecystectomy found that TEA demonstrated a significantly longer duration of analgesia compared to ESPB.