Ultrasound-guided erector spinae plane block using bupivacaine with or without dexmedetomidine in laparoscopic cholecystectomy

Background Pain after laparoscopic cholecystectomy depends on multiple factors, including rupture of blood vessels caused by rapid distension of the peritoneum, traumatic traction on the nerves, trauma to the abdominal wall during port insertion and gall bladder retrieval and pneumoperitoneum created by use of CO2 to maintain high abdominal pressure. It is reported that incisional pain is more intense than visceral pain and is dominant during the first 48 h after laparoscopic cholecystectomy. Patients and methods A prospective study will be carried out in Alexandria Main University Hospital on 70 patients American Society of Anesthesiologists I, II physical status aged 18–60 years scheduled for lap cholecystectomy after approval of the Medical Ethics Committee and informed written consent. Patients will be categorized into two equal groups: group 1 (35) will receive a bilateral erector spinae plane block (ESPB) with an injection of 20 ml 0.25% bupivacaine in each site of injection and group 2 (35) will receive a bilateral ESPB with an injection of 18 ml of 25% bupivacaine plus 2 ml dexmedetomidine 0.5 µg/kg in each site of injection They were evaluated for postoperative pain intensity, duration of analgesia, and opioid consumption during the first 24 h postoperative. Results Higher pain intensity score (visual analog scale score) in group 1 starting from 12 h postoperative with a mean value of 3.29±0.79 (P<0.001) versus group 2 with a mean value of 1.20±0.41 (P=0.151), the visual analog scale score started to increase significantly in group 2 at 24 h. There was a longer duration of analgesia in group 2 with a mean of 20.17±4.07 versus group 1 with a mean of 14.97±5.99 (P<0.001), also, group B showed lower opioid consumption rates with P value less than 0.001. Conclusion Comparing ultrasound-guided erector ESPB using bupivacaine with dexmedetomidine (group B) to bupivacaine without dexmedetomidine (group A) in laparoscopic cholecystectomy provided superior analgesic effectiveness, longer duration of analgesia, and less opioid consumption in group B.