Erector Spinae Plane Block Versus Peritoneal Block with Lidocaine-Magnesium-Epinephrine for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Prospective, Randomized, Double-Blinded Study | ||
| Medicine Updates | ||
| Articles in Press, Accepted Manuscript, Available Online from 30 October 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/muj.2025.431082.1270 | ||
| Authors | ||
| Nada Kamel1; Mohamed A.Ghanem2; Mohamed Sultan3; Sameh Ghareeb* 3 | ||
| 1Assistant lecturer of Anesthesia and intensive care, Faculty of Medicine, Port Said University | ||
| 2Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt. | ||
| 3Department of Anesthesia, Intensive Care, and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt. | ||
| Abstract | ||
| Background: After laparoscopic cholecystectomy, somatic, visceral, and classical shoulder pain often occur. Enhance Recovery requires preoperative analgesia to prevent opioid reliance, increase early patient movement, and expedite recovery. An adjuvant-enhanced lidocaine, magnesium sulfate, and adrenaline cocktail was used to compare the Erector Spinae Plane Block (ESPB) and Peritoneal Block (PB) for elective LC analgesia. Methods: Fifty-two ASA I-II elective LC patients were randomly randomized to two groups: Group E (n=26) got a bilateral ultrasound-guided erector spinae plane block at T7, while Group P (n=26) had a laparoscopy-guided peritoneal block. Both groups received the same lidocaine, magnesium sulfate, and epinephrine. Duration until analgesia request was the main consequence. VAS pain scores, shoulder discomfort, morphine use, serum cortisol levels, bowel function, and side effects were secondary outcomes. Results: Demographics and intraoperative hemodynamics were similar. ESPB significantly increased the time to the initial analgesic request (113.13 ± 24.35 min. vs. 98.27 ± 19.59 min., P = 0.021) and lowered 24-hour morphine use (5.38 ± 2.82 mg. vs. 10.62 ± 2.5 mg.).). Overall, ESPB patients had less shoulder pain. There were similar abdominal pain and cortisol VAS readings. ESPB patients exhibited faster bowel function recovery (14.29 ± 4.10 vs. 18.15 ± 4.14 h; p = 0.001) and fewer surgical complications than the control group. Conclusion: Ultrasound-guided ESPB offers superior analgesia compared to PB in LC. It reduces opioid need, provides better shoulder pain control, and enhances bowel recovery, making it a valuable part of multimodal analgesia for laparoscopic surgeries. | ||
| Keywords | ||
| Cholecystectomy; Erector spinae plane block; peritoneal block; multimodal analgesia; shoulder pain | ||
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