• Xin Huang, Jiao Wang, Juntao Zhang, Yi Kang, Bhushan Sandeep, and Jing Yang.
• Department of Anaesthesiology, West China Hospital of Sichuan University, Sichuan Province, Chengdu, China; National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Sichuan Province, Chengdu, China.
• Br J Anaesth. 2022 Sep 1; 129 (3): 445453445-453.

BackgroundLaparoscopic hepatectomy is associated with trauma and severe pain. We examined whether bilateral, ultrasound-guided, single-injection erector spinae plane block (ESPB) could improve on postoperative analgesia compared with patient-controlled intravenous analgesia in patients undergoing laparoscopic hepatectomy.MethodsFifty adults were randomly allocated to receive patient-controlled intravenous analgesia alone or combined with bilateral single-injection ESPB (ropivacaine 0.5%, 15 ml on each side). Primary outcome was resting pain scores at 3 h postoperatively assessed with visual analogue scale (VAS). Secondary outcomes included VAS scores at rest and during movement at 6, 12, 16, 20, 24, 48, and 72 h postoperatively; use of intraoperative opioids; postoperative rescue analgesia; sleep quality; time of first ambulation; ESPB-related complications; and ropivacaine concentration in plasma.ResultsThe ESPB group showed lower resting VAS scores at 3 h postoperatively (mean [standard deviation]), 2.0 (0.5) vs 4.3 (0.7), P<0.001, and significantly lower scores at rest and during movement at 6-24 h postoperatively. The ESPB group showed lower intraoperative opioid use, lower consumption of rescue analgesia within 72 h postoperatively, and better sleep quality. ESPB subjects began to ambulate 10 h earlier than control subjects. None of the ESPB subjects showed ESPB-related complications, and analysis of a subset of subjects showed that ropivacaine concentrations in plasma decreased gradually over time.ConclusionsCompared with patient-controlled intravenous analgesia only, preoperative ultrasound-guided erector spinae plane block can improve postoperative analgesia, reduce opioid demand, and accelerate recovery in patients undergoing laparoscopic hepatectomy.Clinical Trial RegistrationChinese Clinical Trial Registry ChiCTR1900020961.Copyright © 2022 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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