Analgesic effect of ultrasound guided regional block in laparoscopic cholecystectomy

Introduction: Laparoscopic cholecystectomy (LC) is a proven, gold standard surgical procedure for 
management of gallbladder stones. Early and easily recovery, less operative morbidities, less 
postoperative pain, earlier return of bowel function, improved cosmetics, an earlier return to full 
activity, less hospitalization day and decreased overall cost are the superiorities of laparoscopic 
cholecystectomies comparing with open surgical procedures (Rubert et al., 2016). Aim of the work:
Comparison of the efficacy and advantages of Erector Spinae block versus Quadratus Lumborum 
block on post-operative pain in laparoscopic cholecystectomy operations. Patients and methods:
After ethical committee approval and written informed consent were obtained from all patients, this 
prospective randomized double blind controlled study was carried out at El-Minia University Hospital 
during the period from April 2019 to December 2019 on 60 adult patients of both sex, their age 
ranged from 18-70 years of American society of anesthesiologists (ASA) physical status I and II 
scheduled for elective laparoscopic cholecystectomy under general anesthesia. The patients were 
randomly allocated into three parallel equal groups of 20 patients in each group by using computer 
generated table. Group Q "Quadratus lumborum block": Received bilateral ultra sound guided 
Quadratus Lumborum block using 20 ml Bupivacaine0.25% (on each side). Group E "Erector spinae
block": Received bilateral ultra sound guided erector spinae block using 20 ml Bupivacaine0.25% (on 
each side). Group C "Control group": Didn't receive any of previous blocks neither Quadratus 
Lumborum nor Erector Spinae blocks. All groups undergo the same anesthetic technique. The 
following variables (SBP, DBP, MAP, HR, SpO2) were recorded just before induction, after block, 
intraoperative and at 5,10,20,30,40,50,60 min. after the block then every 15 min. until the end of the 
operation. Total intra operative fentanyl requirement, total number of patients needed fentanyl,
Postoperative: Recovery score, HR, MAP and SaO2 at 1, 2, 4, 6, 8, 12, 16, 20, 24 hour post-operative, 
VAS at 1, 2, 4, 6, 8, 12, 16, 20, 24 hour post-operative, time of The first analgesic request.Total 
analgesic requirement of fentanyl.Incidence of any side effect and time of discharge from recovery 
room. Complications: injury to the underlying structures, hematoma formation as recorded under 
ultrasound guidance, post- operative nausea and vomiting., pruritis, urinary retention, Bradycardia and 
hypotension and respiratory depression. Results: Hemodynamic and VAS were the least in group E 
followed by group Q while it was the highest in group C. Conclusion: Ultrasound guided Erector 
spinae block before laparoscopic cholecystectomy operation was effective in fulfill analgesia postoperative and decrease intra and postoperative hemodynamics, VAS score postoperative and facilitate 
ambulance postoperative when compared to group Quadratus Lumborum and control group.